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Mobile Home_Wright (2) ;; CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR CREDIT/STANDARD DEDUCTION HC10 ilkS. State Form 5473(R6/4-03) Prescribed by the Department of Local Government Finaric gg INSTRUCTIONS:See reverse side Irr filing instructions ti.I?te 1. . —M -- - • '' - CERTIFICATION STATEMENT . fn1 - I(We) o certify t®n2ne)po 15Z 05of March,20_ I(We)occupied as our principal p of residence the flowing described real property for which a Homestead Property Tax Credit is hereby claimed: ❑ I(We)owned ❑ Are ng under contrac�ctt111t y gVe�t �tv,I(�j�(/�', .� Have a beneficial interest in the entity that is liable for the properly taxes on the property and that ownGIBSON Gg 9 Hw R a contract. r,. _J+'_'cr;L3,I'll' 1*- . ., ..,._ : ` I'A't);'(:4.,;`- CONTRACT'RECORDED - ._ _ - if buying on contract,Fee Simple owners name Recorders office where contract is recorded Record number Page Couou � PROPERTY DESCRIPTION? Township Taxing districtict( ty, ownship)• 3 � y -I number �v Mt Legal description Is the properly aqueestion: 1Q�1—� q� W � al property �hlobil o o I.C.61.1-7) ' If any portion of the residential structure or the Land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion of the properly utilized to produce income. /� � r \ Ith L6Y110\ / 9 gG -a', vnev u- cLwiftr,"tr ?,t, . - PROPERTY OWNED BY CLAIMANT IN.OTHER'COUNTIES` - '? S:Iiu' County Township County Township I hereby certify the above statements are true,correct and complete. S�iatu claimant N 262 .4. — _tl�re/'�s/s,[(numb�er,,a�nd/street,city,state,ZIP code) / '1 / /317 y.q14 On)f—fr t.: ✓sue k.J*i {ar'�"' `'`' ""-� - TRUE TAX ASSESSED VALUE - -HOMESTEAD NON-RESIDENTIAL, $:,T'`s1x sy c .ASSESSOR USE ONLY . - sNI•Atet:i e.4., A -x, :a.,= �: _._ . -. - • VALUE AT 100%OF.TTV i' VALUE - - • ;a;VALUE,, Land not exceeding 1 (one)acre immediately - - . surrounding residential improvements. (1) • Other land (2) .((- Total land(line I plus line 2) (3) Dwelling (4) Residential improvements or Annually - ' - �`-j`rK""''^"' t Assessed Mobile/Manufactured Home _�'�"'.::''''"-�.� Garage (5) - .'"-it'- .I. ' l Other improvements (6) Trial improvements(line 4 through line 6) (7) Tctal value (line 3 plts 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 +f... r. t , .- ti- :;?: - - -STANDARD.DEDUCTION ALLOWANCE .- _-_. - - �t_ 20_Pay 20 n ^` �\\ \ y Lesser of 1/2 Homestead \� \(A 1�5k ` valuauon or S35.0 ` Si of uurddditor n f,I�/ \ ` s t C Date ss a3-os