Homestead_Wagner (5)E R��
e.� '� CLAIM FOR HOMESTEAD PROPERTY TAX
_;���� CREDITISTANDARD DEDUCTION
:�,`�� Sute Porm Sa73 (R2 / 5-92)
INSTRUCTIONS: See reverse side !or filing instructions.
FORM YEAR
�° �� _ _ , �T�
I(We) l�Y ,(�Y \ Cr Q � e1l yrQ�T�iat St'day of March. 19�
I(We) occupied a�al place of residence the follovnng described real.prope for which a Homesry�u�b� au Credit is hereby Gaimed:
� I(We) owned ❑ Are buying under contrect �
��-lave a beneticial inierest in the entity thai is liable for the propeny taxes on ihe pmperty and thai owns ihe property or is buying under a contract.
� CONTRACTRECORDED � �
It buying on conhact, Fee Simple owner's name ' -. . ,
flecorder's office where contract is recortled Record number Page
Counry
TownShip
Pao �O �er V I� U� D� I Legal description Pt� N t,v� il.�- 3 3_ a=l D � i ��
If any ponion of the residential stmaure or Ihe land not exceeding one (1) acre �hat immediately surwunds ihai suucwre is used to produce inwme, describe [he use and potlion
of the pmperry utilized ro produce income.
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD . NON-RESIDENTIAL=
VALUE VALUE VALUE VALUE
Land not exceeding t(one) acre immediately � .
surrounding residentiat improvemenis. (�) . . -'
Otherland (p�
Total land (line 7 plus line 27 (3)
Dwelling (4) . �
Resideniial improvemenis
� Garage (g) �
Other improvements (6)
Total improvements (line 4 through lina � (7)
Total value (line 3 p�s line 7� (g)
I hereby certify ihe above is irue, correct, and Signature of Assessor Date signed
complete.
Verityirg action - Signature ot Autlitor Date signed
19_Payt9_
Lesser of 1/2 Homestead
Valuation or 52.000
Sgnature of Audi;or
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