HomeMy WebLinkAboutHomestead_Wagner (7)a � i CLAIM FOR HOMESTEAD PROPERTY TAX. _
;��� CREDIT/STANDARD DEDUCTION
.�.; � Stare Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side lor (iling instructions.
� l� .' ' ' _ � ` �' n �� � . '� CERT�FICATIONSTATEMENT
FORM - - - YEAR
HC10
•.
i (we) 'NLX "f� 1___ _�__I LUIl • . ceni(y that � �i �y`g(�arcn, i s
. ..
�e upied as our principal place of residence the following described rea property for which a Homesiead Prop ax r it is iiereby claimed:
;J I(We} owned ❑ Are buying under con�ract ; _ - /n/
❑ Have a beneficial interest in ihe entity ihat is liable for ihe property taxes on the propertyand ihat owns ih��r y�r�un6er.�co ; act.
� - � � - , . - � � .. . �CONTRACT�RECORDED ,, . -� � � . ' . .
If buying on conttact, fee Simple ownefs name . � - . � . - � �
Recortlefs oHice where contraa is recorded pecord number Page
County _
t_
Township
Legaltlescnption
town.
i
ZJ✓ �0�� �LiIJ - ' . .
of the residential structure or (he land not exceeding one (1) acre that immediatety surtountls that strucmre is usetl to protluce income. describe Ne use and portion
y utilized to produCe income. _
PROPERTY OWNED BY
certify ihe above statemenis are irue, correci and comptete. �,!
�
f�;�nber �treet, dry. stare, ZIP cnde) _� �' �
% � A� C1`Y /' ,L�IiP /1
� - ASSESSOR USE ONLY
Land not exceeding 7(one) acre immediately
surrounding residen�ial improvements.
Otherland
Total land (line 7 plus line Z�
Dwelling
Residential improvemenis
Garage
Other improvemenis
Total improvements (line 4 through lina �
7otal value (line 3 p�s line 7)
I hereby certify the above is true, correct, and
complete.
Verifying atlion - $ignaNre of Autlitor
(�)
l2)
(3)
(4)
(5)
(6)
I�I
(81
TRUE TAl(
VALUE
ASSESSED I HOMESTEAD
VALUE VALUE
Date signed
Dare signetl
. STANDARD DEDUCTION ALLOWANCE - �
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52.000 S . �
Synature of Audiror Date signed
VAIUE .