Mobile Home_Watkins P FORM
t CLAIM FOR HOMESTEAD PROPERTY TAX
,( CREDITISTANDARD DEDUCTION • ,
State Form 5473(R614-03) •,
Prescribed by the Department of Local GovernmentFinano_ �----
—INSTRI.If_nerd c_coe Juzfr-.„-.. .... r-----T
YEAR
CLAIM FOR HOMESTEAD PROPERTY TAX POR+b
'� STANDARD/SUPPLEMENTAL DEDUCTION Hcio
4
in
sin Rem 5a73 R (R 6)
esgiaed g/Ne Departmentalltta GwaraettFse1ce
INSTRUCTIONS •-reverse side hNh6g Ind' mantas are cprySpmGNnanderlC 61.1-12J7.
NOTE TeAepf101e. •... SeaxfiX driver's kens&state derdSceLM andfederaf Itl ATEMEN
��CEF.TIFICATION STATEtdENT
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(� 5/nil I/l_e./- certify that I(we)occupied as my(our) r �✓
1 Ohms
under contract for which a Homestead ProPertY Tax Standard t
Plarn d residence or am care)buying date ,described�I property (data o/s(g a). 12/6
Ded,ldior,is feeby claimed an the this application slg lar
SO
❑ Ovm ❑ Am(�)buying under recorded contract. N OO/7i-a. .
❑ Am(are)entitled to ucaepy as a tenant-stockholder of a cooperative holding corporation. t
Irderest m the mat or the tight to occupy. the Properly render leans of a Wal'Ified persons residence Y
❑ Have a beneficial" nit
❑ Am(are)the shareholder,partner,or mem•- of the entity that owns the property. -
"' O
%' "CLAIMANT'S INFORMATION
fin
Soda seam numbs(dmlatss+wa(Iasi five
dgas) OWd s spouse' mss rot Clow� '� ) IS-VaASn
g Pl '`y J -t
it busing wartFee Salgta oamfsr®re n
Remeers race'Mare mWNuri is recorded Rmsd rvmav Poor
--Art v - - - - DESCRIPTION- PROPERTY _ _ , . .
Tomah% Tmg•-..fay;mint • p
a nig _ 5 �y�
�/n// /// b/0 /C//7 0 ////'/�� /p IS pro0mlY n gleIDwc 0
lag / 'O L/ 9 iolad tw B❑Real yin qua A+ss•b assessed oadssme(K 61.f-])
® Item••.•• tine residartdl meant cr lard rol«medlg one(1)sae Mal immeately samaNs riot uniciaeb used Gene vme.devlm ore tore and Foam
Cl the ptopedy toted b produce insane.
s :' ._. . - _ --PROP,ERTYOVJNED.ELSE'NHEREBY CLAIMANT-?„'gP 7
_ ^— -c,r,7 -3,U:,?
Stabs sty,and Tonto r Is clamant vacating a homestead?
❑ Yes 0 No
Gaaoae of amnmtl
I hereby certify the above statements are tare,correct.and complete. (yam/`
Maass a asraa(rantsme sand city..•.b,and ZIPaade) Address maned lgrrosbad.aany Member era Meet,city.SCe.and ZIPsode>
ASSESSOR USE ONLY _ /it . SESSED.VALUE I HOMESTEAD VALUE I - NON"'V4LUE �RESIDENTIAL 3 ?
Land not exceeding
wrroumu ng residential b(tn moveinents immediately (1) gatt�y-1sY -4•7%- - - ;
Other land (Y) ? a was:= ,
Total land(line 1 plus line 2) (3)
L t_S.
Ftesidentiala1 assessed
improvements or Owminp (4) ;-L.za - .- t_-r,.
manufactured
assessed mobile/ ` s - .
manufactured home range (5) .. 5_...t,... . v.. 'v
Other improvements (6) y ,e1 ;If>'
Total improvements(line 4 through fare 6) (7)
Total value(line 3 ohs line 7) (a)
I hereby certify the above is true,correct, Signaure a Assessor Om signed(north.day year)
and complete.
Vatting amen-Signature aAvdter Ode signed(nand;day,)ear)
41)
20 pay 20 Lasser of 60%of the assessed vase of the homestead or$45.000. ..
Noas(fhsianlag any otherpmvtzm,the sum of the deductions povlded in IC 6-1.1-12 to a mobile home $
that is not assessed as real popery arto a manufactured home that is not assessed as real pope*may
rot exceed one-hal(t?)of the assessed value of the mobile home or manufactured lame.
Signature aharem _ I Date aged(moan.day ya d
d51RIWDdN:(Signal-Corny Auffor. a- cad Copy-Tamara
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