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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / 592)
INSTRUCTIONS: See reverse side for filing instructions.
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CERTIFICATION STATEMENT `-� _ � /
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I(We) � certify that odthe�tst day oI Mna�}ch, 19_
I(We) occupied as our principal place of residenc the following described real property for which a Homestead Property Tax Credit is hereby Gaimed:
❑ I(VJe) owned ❑ Are buying under contract
❑ Have a beneficiai interest in the eniity that�is liable for ihe property taxes on the property and ihat owns the property or is buying under a coniract.
CONTRACT RECORDED �
It buying on contract, Fee Sunple owners name �
RecordeTS office where conVacl is recortled - Record number Page
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PROPERTY DESCRIPTION
Counry To hi Taxing tlisirict (ciry, town, Iownship)
Parcel number L al ri tl
0 - � S��d 'l—/U
It any portion ot Ne resitlential sWCture or the land not exc ing one (1) acre ihat immetliatey surtounds thai structure is used ro produce mcome, describe the uu and poNOn ot
the properry uti¢eC to produce income.
� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Tovmship
Signature of daimant
. ereby certify the above statements are We, correct and complete. � �
Adtlress (numbe� and sfreet, ciry, state, ZlP code) �
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(oneJ acre immediately �� �
surrounding residentiai improvemenis.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements .
Garage (5)
Other improvements (6) .
Total improvements ((ine 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is frue. COVeCt, and Signature af Assesor Date signed
complete.
Veritying acGOn - Signature of Audimr Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
V luation or 52,000 �
Sig al Auditor � Date signetl
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Individuals and married couples are limited to one homestead standard deduction. r1s the recei�
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Hoi
•fraud causes higher tax bills for all; therefore, HEA 13�t�t-2009 requires taxpa��ers ��•ho recei�
homestead standard deduction to verifV that they are eligible to receive the benetit and to pr
additional indentifying information necessary to allo�r• county government to better monitor ho
filings. This information will be kept confidential and can only be accessed bti� authorized count��
The Department of Local Government Finance �r•ill use this information to create tools that w
countr� officials eliminate homestead fraud.
Propeny Addass (number and stree� ciry, state, and ZIP code)
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Parcel Number
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(number and street, city, state, and ZIP code)
KumberQaztS
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Address (\umber and stree�, city, state, and "LIP calr)
Securiq• Number (lut
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Same u pwperty address
� Same az property address
of this r'
�stead
the
ide
estead
'ficials.
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undersigned certifies, under penalty of perjury, tha[ [he abo�•e and foregoing information is we and correct and that he oi she is
le to receive the homestead standard deduction on this property. Each undersigned also understands that, by claiming additional
stead deductions unlawfully, he or she may be liable for back ta�es and substantial financial penalties. I�
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