Mobile Home_Williams /o6(
%�`•'•'•') CLAIM FOR HOMESTEAD PROPERTY TAX ' FORM YEAR
CREDIT/STANDARD DEDUCTION c o
"la:� State Form 5473(R6/4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse ale for fang irttructione. AUG 3 1 2005
0..-4`sG`)ri, :iiri�;-�tiaswz=;:sus 'w '�+�s' ,s`"?r t4cERTIF.ICATION STATEMENTc lF- ;,; , 7'1 ,;.'fir e _' 1rr `s-;Y :s
I(We) #7' S certify that m2egas
4t' march.20_
I(We)occupied as our principal place of residence the following described real property for which a Homestead INgig617agObit4Tir;lt" i%'QT1med:
❑ I(We)owned ❑ Are buying under contract
• 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.
w.=M�rtt_:.y.„Rag X..- ... ,� _e tY ''''rfy. _ r•a —
r.=.+v-.rtrli3ti.SwW"§t�'si'-Kam�c�'�r�- ri:bCONTRACT.;RECORDED' `'�{,�. ��"�,s•�?�,��, t? ,y;
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
ear..r=`- �..�2T -Wrat:�zr" `�`",sEm°a_tr� IP,ROP,ERTY<DESCRIPTIONeiMar;��;:a``:'t: ns`M'-a ., W t
County 1 / - Township Taring ist (city, wn,township)
P. y �, //J o2 'j ,/J) Legal description n o l Is the property uestion:
i_ [ S —U v , /wp� u.,c„.23 Real property ❑ Mobile Homo KC.6-1.1-7)
0 .r portion of the residential structure or the land not ex ing one 1) iae that immediately surrounds that s sure is used to produce income,describe the use and portion
of the property utilized to produce income.
r..d-'rt"Y:3„•'� -,�r�� `�� PROP,ERTY.OWNEDBI!CL'AIM/1NT,INrOTHERCOUNTIEaWatV.'arl�#a`-
County Township County Township
I hereby certify the above statements are true,correctand complete. S nature f clai
Address(number and street,city slate,ZIP code)
;y=cYq' '- s` zgYfa j' ''TRUE TAX ASSESSED VALUE a OMESTEAD`-'`'"' `NON-RESIDENTIALLr' n
ASSESSOR�USE ONLY" M VAI.UMw s�.: ' y�����' � �"'VALUE3c� �-ATx100YOF�TfV� �.VALUErC's� .s..i. _ c'7'`.�.
Land not exceeding 1 (one)acre immediately , ' 'ify '; .YS'P- 'r"1, fcs c%j
surrounding residential improvements. (1) ET' `"t,- .f,+' �t"".ij'
Other landil.
.moo'21tS. s
Total land(line 1 plus line 2) (3)
Dwelling (4) per .;'-soss
Residential Improvements or Annually
Assessed Mote/Manufactured Home Garage (5) ptirenc„
Other improvements (6) - at .
Trial improvements(line 4 through line 6) (7)
Trial value (line 3 plus 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..r,2UE.i'-_. -n e `�' ice--STANDARD':DERUCTION ALLOWANCE�`" `••`tIV.` t ' :'_ to
• 20_Pay 20 (t
Lesser of 1,2 Homestead,\ •n
valuation Of S35.000 \
Signature of Auditor \ \v \ Date signed