Homestead_Wallsa �� CLAIM FOR HOMESTEAD PROPERTY TAX • FoRM YEAR
a��;: CREDIT/STANDARD DEDUCTION '- HC�o Cj�
� StateFOrm5a73�(R2/592) '' `�- �
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INSTRUCTIONSr See reverse side lai /iling instructions. , ��� � o l�Ap
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. � � . .. , � �. CERTIFICATIONSTATEMENT . ' � ..
e)_�__ `��_ _ �� � certify�that�onihe-7si.`t�ay,-��e�h, 79�
,,.Je) occupied as our principal ce of residence theiollowing described real property for which a HomesieadProperty Taz Credit�is hereby claimed:
❑ I(We) owned ❑ Are buying under wniract
❑ Have a beneficial interest in the entity that is liable tor the property taxes on the property and that owns ihe property or is buying under a contract.
� .
. CONTRACTRECORDED '
If buying on contraci, Fee Simple owner's name
Recorder's oHice where contract is recorded , Recortl number Page
' PROPERTY DESCRIP'fION -
Counry � Township Taxirg tlistrict (ciry, fown, township) -.
. . . �. ' . � - �
Parcel number Legal description ^ �� —
� �s- a-�� �
If any ponion of the resitlential strucmre or the land not enceeding one (7 � aae ihat immediatety surwunds ihat structure is usetl to produce income, tlescribe Ihe use arW portion
ot the pmpeny utilaetl ro protluce income. _
� PROPERTY OWNED BY CLAIMANT IN
Caunty Township County
certify the above statements are true, correct and complete.
Adtlress (numberandstreei, ciry. stafe. ZlPCOde)
a
ASSESSOR USE ONLY - �, TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL.
VALUE VALUE VALUE . VALUE �
Land noi exceeding t(one) acre immediately
surrounding residential impmvements. (� � �
Otherland (p) - ��
I
Total land (line 7 plus line � (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 Irue, correct, and Signamre of Assesmr Date signed
-^mptete.
yirg attion - Signature of Auditor . Date signed
STANDARD DEDUCTION ALLOWANCE
. 19 _ Pay 79 _ .-cJ`-" l
Lesser ot 1/2 Homestead � - �� ��
Valuation or 52,000 S - - - - �
SignaWreolAuditor n ^ �/ - '