HomeMy WebLinkAboutHomestead_Freed�•=�"� YEAR
e! q CLAIM FOR HOMESTEAD PROPERTY TAX
i���'= CREDIT/STANDARD DEDUCTION � - �
:�,;' State Fortn 5473 (R2 / 5-92) ��EB 2 2 1 94
INSTRUCTIONS: See �everse side for liling inshuctions.
CERTIFICATIO A ENT
��We) _ cenify ihat on ihe ist day of March, 79�
�ie) occupied as our principal pl ce of residen e he following described real propeny for which a Homestead Property Tax Credit is hereby daimed:
I❑ I(we) owned ❑ Are buying under contraci
❑ Have a beneficial inierest in the entity thai is liable for Ihe property taxes on the property and thai owns the property or is buying under a coniract.
' PROPERTY D N
Counry 7ownship axing �str ciry, own, townshi .
��
Parcel number Legal rip n
-��oa -CJ uJ - - I ) . 8� A�.
If any ponion of the residential siructure or the larid no� exceeding one (1) aue that immediatety surrounds that strucmre is usetl to produce income, desaibe the use antl
of the property utilized to produce inwme.
PHOPERTY-OWNED BY CLAIMANT IN OTHER COUMIES
Township — Counry
the above statements are ime, wrrect and complete. I Sgnamre o� Caimanf
_� .— -
Address (number and street. ary, state. ZIP mde)
r QL�� C3a� 5 (C �
ASSESSOR USE ONLY TRUE TAX ASSESSED liOMESTEAD NON-RESIDENTIAL�
� � VALUE VALUE VALUE � VAWE
Land noi exceeding 7(one) acre immediately
surmunding resideniial improvemenis. (�) . �
Otherland (p)
Total land (line 7 plus line Z� (3) �
Dwelling (4) " �
Residential improvements ' .
Garage (5)
Other improvements (6)
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line � (g)
I hereby certify the above is true, cortect, and Signawre ot Assessor Date signea
complete. .
�lyi�g action - Signature of Auditor Date signed