Homestead_Whitehead (7)eE< R•n
g CLAIM FOR HOMESTEAD PROPERTY TAX
;��i: CREDIT/STANDARD DEDUCTION
� �� State Form 5473 (R2 / 5-92)
�.�.
INSTRUCTIONS: See reverse side loi liling instructions.
STATEMENT
FORM YEAR
HC70 Q�l
II
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�^Ne) �/ )I OMV�v .� \l�i� �,� ��UV..P.�'Ul.CK� certify ihat on e 1 si day of March, 79�
�e) occupied as our principal place of residenc he following described real property for which a Homesiead Proper�alkiwrJit �er
(We) owned ❑ Are buying under coniract AUDITO��
❑ Have a beneticial interest in the entity ihai is liable for the property taxes on the property and ihat owns ihe property or is buying under a coniract.
� . CONTRACTRECORDED ��
If buying om m�trau. Fee Simple owner's name --
Recorder's ottice where contract is recorded Fiecortl numher Page
PROPERTY
Counry
Parcel number Legal descripti ° V .
Q4C-co35g6 �r� � S� 5-a-io q.�►�(+tC,
If any portion of t6e resitlenUal strucmre or ihe IarW not ezceeding one (7) acre thai immetlia;ely surrounds that structure is used to produce income, describe ttie use and ponion
ot the property utilized ro protluce income.
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE. VALUE VALUE
Land not ezceeding 1(one) acre immediately
surmunding residential improvements (�) �
Oiher land (2)
Total land (line 1 plus line 2� (3)
Dwelling (4) -
Residential improvements
� Garage (g) �
Oiher improvements (6) -
Total improvements (line 4 through line � (7)
Total value (line 3 pbs line � (g)
1 hereby ceRity the above is irue, correci, and Signa[ure of Asseswr Dare s�gnetl
complete.
tyirg action - Sgnature ot Audiror - Date signetl
�
w
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52,000
3
AILOWANCE
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