Mobile Home_Williams (2)r
<.rt,b CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
' _ CREDIT/STANDARD DEDUCTION HC18 Ilk
.e /• State Form 5473(R5/10-01) - --
at. Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
),7 o- e ";y ' -�`' ;.: *. ' t . CERTIFICATION STATEMENT . - _r"
1 � i1 I(We) certify that
�.lo�n[the 1st day of arch0
I(We occupied as our principal place of residence the following described real property for which a Homestead Propeg7f TaQC3eddQfnttereby claimed:
I(We)owned ❑ Are buying under contract � OIL
lave a beneficial interest in the entity that is liable for the property taxes on the property and that owns a grope As bt g undef6 c ract.
SI330il t,L47PJT1 AUDITOR
i'tik:' arif. 't' t=1' ` tdi . , 1,..:5"'... f z.'- CONTRACT._.RECORDED ti i`' - Tis . p .- f.- -... `
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
_:. .. asczs s 3 r De$:}'s"rt ._ - .- -, S i T s-'.--i- , t+`t"y. '-
County ,�_T-:- :r__?3"'�' t-<, .'�:�' . .' PROFERTK.DESCRIP,TION',-'; 1_ . ,... . ` " �` '
County n Township _•, '- Taring district(city,town,towns/h�ip) -'
Parcel-n-u-m�ber T ae Legal description Is the property in question:
j„J y a - co a_00 $ p ❑ Real property .,obits Homo(LC.6-1.1-7)
If any portion of the residential structure or the Land not exceeding one(1)acre tha immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
r'_,-T-u .o -�'s',.> u'; ,a,,, "-16PROPERTYOWNED BY CLAIMANT-INi OTHER'COUNTIES " .t;: :i +.'txty.4p'+.-3u ' `-. ri0"r' -
County Township County Township
5.I hereby certify the above statements are true,correct and complete. n bre of claimant
dress(number and she city,state,ZIP code)
• R \ ao S
' -" X4, . - ' i.e :x:'-� - 23 TRUETAX . ASSESSEDVALUE HOMESTEAD?' 1+ -3 NONRESIDENTIAL 'I'
,¢r ,� eg.:E, SOR US> ONLY: f). .,- +VALUE;s >: " AT100%OF.TTVA ..,:VALUE5 :. z.> ,??VALUE :'sfin,':`
Land not exceeding 1 (one)acre immediately Ff i F `
surrounding residential improvements. (1) ' „� - ..-r: `
Other land (2) - .-' .-:.;A
Total land(line I plus line 2) (3)
Dwelling (4) 'i -t st t +"'
Residential improvements -,t, fi ,
Garage 6) T1r "=t.ng n tt =z
Other improvements (6) �Total improvements(line 4 through line 6) (7)
Toal 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
gil% lfs *Z 'y d -r ';_MSTANDARD.DEDUCTION ALLOWANCE .:";:w,41y -:;--;.,',, a.. ...-: "K'r >. ':,'1:1
js Lesser of 1I2 Homestead 5 'd ‘Ar\R
Valuation or$6,000 \ \ `
Signature of Auditor Date signed
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