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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State fortn 5473 (R2 / 5-92) �
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CERTIFICATION STATEMENT .%J,�
�) �� ^ n � � " U� TY AUDITOR
I e ��- � aA.-�Vi ceniry that on the 1 st day of March. 19_
� I(We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credii is hereby claimed:
�(We) owned ❑ Are buying under contract
Have a beneficial interest in the entiry that is liable for the property taues on the property and that owns the property or is buying under a contract.
CONTRACTRECORDED
It buying on contract, Fee Simple ownefs name
Recorders oHice where conVact is recorded Recortl number Page
PRbPERTY DESCRIPTION
Couny - Township Tazin istrict (ciry, t , township) �
Parcel number Legal description
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If any portion ot Ne residential slrucNre or the lantl not exceeding one (1) acre that immediatey sunounds that structure is used to protluce income, tlescnbe the use and ponion of
the propeM utilized ta praduce income.
PROPERTY OWNED�BY CLAIMANT IN OTHER COUNTRIES -
Counry Township Counry � Township .
Signature,ej daimant � �
ereby certify the above statements are true, correct and complete. \� '1
OlJ(.JY�.i'r'�c�..l
Address (number and stree(, ciry, state, ZIP cntle) �
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediatety �� �
surrounding residential improvemeNS. � �
Oiherland (2)
Total land (line 7 plus line 2J (3) �
Dwelling (4)
Residential improvements
Garage (5)
Other improvemenis (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby Certify the above i5 We, Covect, and Signamre ot Assemr Date signed
complete.
Verifying action - Sgnature ot Audimr Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
Valuation or 52,000
Signature of Audita Date signed