Homestead_Simpson (5)CLAIM FOR HOMESTEAD PROPERT( TAX
CREDIT/STANDARD DEDUCTION
t State Fwm 5473 (R6 / 4-03)
Rescri0ed 6y Ne Department of Local Govemment Finance
INSTRUCTIONS: See �everse side !or filing instnictions.
FORM t�`! YEAR _
Hcio
� �e) ������ � �{'��L�'�"'""'"-� �'`��� certify Ihal°� t/h�_�1 d MYar�!1!17
I(Wej occupied as our principal place of residence �he tollowing described r al property (or which a Homestead Propeii'y Ta4 Credit i�NBfEby daimed:
❑ I(VJe) owned ❑ Are buying under contract
' Have a benefidal interest in fhe entity that is liable for ihe property taxes on Ihe property and that owns the pmpe orls;buyTF�q �8pr a contracl.
116uying on conVap, Fee Simple ownefs name
Recordels olfice where coniracl
Cauny '� ,
Tamship
EiStriFt (city, tawn, tawnshiP)
Record number � Page
Parcel number LAeg�a/l�.d'escriptionn 1 C ) ?�- � � Is the properry in question:
�0 �� Q���� /" L�/� / v L d+ �✓ j� Q [�.R¢al property ❑ MobOe Ho o(/ C 6�1 f-7)
H any port�on ot the resWentlal sW cture w the land not exceeding one (1 J acre that immediatety wrrounds Ihat sWCture is used b Droduce incame, describe Ue use and ponbn
ot Ihe properry utilized b produce irrcome.
a �-�� -a5-a6 � -o�a.a i 1�-oa.5
Tornship
I hereby certiy the above sWtements are lrue, coned and complele.
street, city, sJate, ZIP cade)
Couniy
�> 3^ c.�`'t��'�i Jg+.� �i�i. �£,•�y�i r_ � c� �-c .._ �o e...�-�s. ,r sec p -- ✓
#�Z..t ,.` ASSESSOR�USEONLY� 4�-'�`� �� ��VALUE �gr� AAT100%OFTTV �HOVALUE DF�'�s���'N s,. VALUE��%cx�
�.'3.5��2.r'E.� 3i'#�'� a..f�+.��'�: _.:i�., � < � .^ti� T..� t��*�+a�A. � -,...�.,r�.�.`�a3�
Land not exceeding i (one) aae immediately �-T� ^r „�� � � � *„
suvounding residential improvemen�s. (� � ���. ;� �� Z Y,�'
Other land -F �� ' `�
�2� 't..�'��
Tdal land (line 7 plus line 2) �3�
'x.'_'�: •'" 4s' 3i-`�''��'�_�-�
Dwelling (4) .�i' v' ' . iw.: . �- -L. �+�'.y�r a
�Residential improvements or Mnualty ' -��'�,-�' . ' - `'�-'� "' . � -''�'�-�'
0.ssessed Mobile / ManufacNred Home Garege (5) ?''£y� s��x'��t,. Y-. ��'�'t03 �� ��•
�`�-t'7ri.4.��+.,.�r9:�ss.�..,t .i.. X`'`.��
-5�:��c �}
Other improvements (6) ;r�,� z'^��'�-�-
�i=31-"4�.`�:ie�
Total improvements (line 4 fhrough line 6) (�)
Tocal value (line 3 plus line n (8)
I hereby certify ihe above is We, corred, and Signature of nssesmr Date signed
complete.
Verilying action - Signature of Audimr Date signed
20 _ Pay 20
Lesserof 1/2 Homes;ead
vauauon a E35.000
S
aflwditor