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CLAIM FOR HOMESTEADPROPERTY TAX
CREDIT/STANDARD DEDUCTION _
State Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side /or /iling instructions.
FORM YEAR
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�� CERTIFI ION EM
I(We) i t f h, 79_
I(We) occupied as ur principal place of residence the following described real property for which a H �p�J�Tc`Gietlmf3�Re y claimed:
❑ I(We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entiry that is liable for Ihe properry taxes on the property and that owns the property or is buying under a contract.
CONTRACTRECORDED
It buying on contran. Fee Simple ownefs name
Recorders oHice where contract is recortled - Record number Page
PROPERTY DESCRIPTION
Counry Township Ta�ng Aistrict (ciry, � )
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Parcel number Legal description
00 -o 00 f C� .33 /- /a 3 C
If any portion of ihe residentia strucWre or ihe land not ezceeding one (7 ) acre that immediatety surtounds Ihat struc[ure is used to produce income, tlescnbe the use arW porUOn of
Ne property uulized to pro0uce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Couniy Township Counry Township
Signature oiclaimant
� ereby certify the above statements are true, correct and complete.
Address (numbei antl street, ciry, state, ZIP oodeJ
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (� �
surrounding residential improvemenis.
Oiherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Resideniial improvements
Garage (5) �
Other improvements (6) .
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8) '
I hereby certify the above is irue, wrrect, and Signawre of Assesor Date signed
complete. .
Veritying action - Signature of Audimr Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _ .
Lesser of 1/2 Homestead $
Val ion or S2,000 '
Siq reo uditor Datesignetlo _�/�
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