Mobile Home_Russelberg 771T1T r' TN
, a � '-1 ii r I I ')YEAR
i; t-4,, CLAIM FOR HOMESTEAD PROPERTY TAX NEORMJ IL i la.
'1;-1 CREDIT/STANDARD DEDUCTION HC10
'` State Fonn 5473(R6/4-03) n 20 5
r Prescribed by the Department of Local Government Finance NOV`� r 1 C
INSTRUC77ONS:See reverse me b Mg itmucfio u PjG
O' ,,.j`p.K�4,}= :4 -f., "_; ,` CERTIFICAllow sTATEMENT:z y»s -ram- Lb w-' -1/ +' ,t-=
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I(We) QJ 2. . n QQ TLp s- t \1 g �11,.` certify that on the 1st day of March,20
I(We)occupied as our principal place of resident the following described real property for which a Homestead Property Tau Credit is hereby claimed:
I&(We)owned 0 Are buying under contract
0 Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
:t:tri�*z-�v�}3 :c�"slaaraais,^=tin`ra,rar�.-'ixr�-"<GOHTRAGERECORDE0=�i3x"r-tom __W.-SSs`�y�� ' eM4a .a=��%n'3..."xAi='f*
If buying o_ant Fee Simple er t 0 /
Recorder's office where contract is recorded \X Record number Page
.?- 3 sit a-4-i:sj...� .'�S�r"t�,�'v `�a;�'�-�•�a -- ?P,ROP,ERTY:DESCRIP.TIONe,Wais�-`�...� `�aTCi-?�'vt�[tlir.'�x_.`'<.,r-rr.in
County '1,Tamship Taxing district(city,town,township)
\3 to i it i _)
Parcel number Legal description Is the property in question:
,i 4 b l — bDE I'1 D^,C Tb 0 Real property ffkCalile Homo(I.C.6-1.1-7)
`fany portion of the residential structure or the II�9nd not exceeding one(t)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of aroN....
properry utilized to produce income. .
3ram6--� '� -Nc,tl� r 9
ifitei�ri_ '4-r -'S' a.ez iNaaROPERT';OWNEDTBY CL'AItnawrdN(OTHER"COUNTIES/<..w..„'-f'":.laa cttaift.-F(`'.'ar+3'i
County Township County Township
I hereby certify the above statements are true,correct and complete. (Pleiti '�'�O
Signature of claimant
eRN�tldress(numbe aM street,city,state,ZIP code)
v A - e i- Y W e��r R TAX4 'Xis ESEDVALUE HOMESTEADe` riaiAESIOEHTrU LLs
n*,' i-YASSESSOR,USEONs " `-f-fl igr&TS -� p+,5. VALUE *s wATa19°S dTTV VALUE t t xVA UEa
Land not exceeding 1 (one)acre immediately ii. a" `'`F-r' ` `'�j1'a
surrounding residential Improvements. (1) "z' ''ram w . ,-.4� �„
Other land (2) %: .. '.t
Taal land(line 1 plus line 2) (3) `a
;ViifDwelling (4) i1 '? ."
'Residential Improvements or Annually
''""' �,.','��'" '
Attsettsed Motile/Manufactured Home Garage (5) nr-,g,, g "" 4 ,
Other improvements (6) c.�.-f y1.5
Tctal improvements(line 4 through line 6) (7)
Taal value (line 3 pits line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
r ',ae gym.- n :amM' ,`rs�.r-;$1., t.STANDARD:DEDUCTIOWALCOWAHCEa `,'1's?rsf!#`f_ , a .e'^'-'`r, ;;€r - !, :E gi. =
i
20 Pay 20
\� Lesser ti n Homestead\� �� \\ \/) �
Valuebnn a 535.000 Uf` I `
Signature of Auditor 6 �,, 1 Date signed
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