Homestead_Johnson (4)?� rt��' : CLAIM FOR HOMESTEAD PROPERTY TAX
= CREDIT/STANDARD DEDUCTION
` : r Sta�e Fwm 5473 (RS / 70-01)
Prescribed by Ihe Department of Local Govemment Finance
INSTRUCTIONS: See reverse side !or filing instructions.
_�=x,r u s�ir:'rr .. -. -. : ... , _ _. �cFwncicen
FORM YEAR i
HC10
�
I(We) � V �(� � certify hat �n the�1 st day of M , 20
i. i . ,r
I(We) occupied s our princ al ace of residence the followin escribe al property (or which a �r�Ta�Gredh�S�(� by daimed:
❑ I(We) owned buying under coniract �` GBSON OU� � Y�UOITOR
�Have a benefidal interest in the eniity that is liable for the properry taxes on lhe property and that owns the property or is buying under a contract.
�c"s:"a'��.�.�..�.YO�s`r5z��; ' -�'.=,�-�-3,ri.-`� '� ,i' :CONTRAGT'�RECORDED ts ' � . .
If buying on conVaG. Fee Simpie owners name
Remrdefs olfice where conVad is recorded Rewrd number Page
:;.'?'"y�,_3. "� �?...'i.''Sr 'PROPERT.Y.�ESCRIP,T�ON�`r�j . t.:: � ?_. :�:._: -„t••y � -_..�..-:�.t
Tavnship Tacing tlislrict (city,fojCn.jownship) .
Parce um� �/���I Le a� �nptio� � /� _� _ Is the property in question:
N �; Real DropeM ❑ Mobila Momo (I.Q Gf.7d)
If any portion ol Ne resitlential sWCture w the Wnd not exceeding one (1 � acre that imrt��tc1 �rtqpn�s that s cture is used to D��uce inwme, describe Ihe use and portion
ot the pmperty uGiized to produce inwme. / .J' J 0•�
County
To.vnship
I hereby certify the above statements are We, correct and complete.
'jtlre��e� and sbe�f, cdy, sfafe, ZlPcode) � �
County
Twvnship
m
y:�:-� �� �,,f.: r r�as � - a �t �. �, `- -- - � � � ..�,
��� �,�"�rASSE550RUSEON YY �;T`t {�... 'STVALUE ;`� AT700%OFTTV. ; H�VALUE D�_. �q��1NON VALUENT���,qf�.'`�
�e . ..F�J"+cy"r a:.lL i �;�}D. . a h 3 . _v � �i:n
Land not exceeding 7(one) acre immediately � ;,� -� <t{ °'�.r- �;'�S s'�',�
surrounding residenlial improvements ��) �f 4"�7}�,�'f ,� ,.:+'h �'����
4 .Ry�t� ��.� � ��
Otherland (p� � n�k"
'='���.:.,, .,
Total land (line 1 plus line 2) (3�
y �,.�. {f �. ^
Dwelling (4) a+Js� t �"�Fy ��`�w�"�'�y� ��;•.
Residentialim rovemenis '`'P'�'����''�' � � �;
P r.r,.�,� z rx't;;-
Garage (5) �-�'`��1'.�x,;,��py�i`�}; ��yn�
�,4�z::r*S��u�.. f,�-�e'�`,.�iz�{��:.-''�:
r_..'�:y�,;. - —
Otherimpmvementa (6) ' ��'��T�_%�itp°.'
Total improvemenLS (line 4 through line 6) (7)
T�tal va�ue (line 3 pLs line n (8)
I hereby certify �he above is We, correcl, and Signawre ot Assessor Date signed
complete. �
Vrrifying action - SignaWre of Auditor Date sgned
20_Pay20_
Lesser of 1I2 Homestead
� VaQatlon or $6,000
�
Da1e siohod _ 1Y _O
7 I ) / (/-1