Homestead_Wilder (3)��R34
E „ CLAIM FOR HOMESTEAD PROPERTY TAX
i��': CREDIT/STANDARD DEDUCTION
„ ,sy� ,` � State Porm Sa73 (R2 / 5-92)
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INSTRUCTIONS: See �everse side lor7iling instructions.
a = � � 5
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e) ��1 v1 u�� �YJ�^°-"��! � certify that on th����ch, ly�
e) �occupied as our principal piace of residence ihe following described real property for which a Homestead Property Tan Credit is hereby claimed:
�e) owned ❑ Are buying under contraci ,
Have a beneficial interest in the eniiry thai is liable for the propeny taxes on the property and that owns the property or is buying under a contract ,
� . CONTRACTRECORDED
I( buying on comracL Fee Simple owner's name . - .. � �
Recortler's oHice where coniract is recordetl Recortl number Page
Counry To nship
Parcel number Legal tlei
00 -03"111
If any portion ot [he residential strucNre or the lantl not
of the property utilized ro protluce income.
T� G-Y-96
PROPERTY
fown, forymship) � - � -
� 'Vlu �� -� � II - • �dfC. ` � .
�g one (7) acre that immetliatety surrounds that swcture is used to produce income. desaibe t�e use and ponion
PROPERTY OWNED BY CLAIMANT IN OTHER COUN'fIES
Counry 7ownship Counry —_ 7ownship �—�
��reby certify the above siatements are true, correct and complete. Signanre ot ciaimani
iress (number and sireel, city, state. ZIP code) �
3 L{ 3
ASSESSOR USE ONLY
Land not exceeding 1 �one) acre immediately
surrounding residential improvements.
Other land
Total land (line 1 plus line 2�
Dweiling
Residential improvemenis
Garage
Other improvements
Total improvements (line 4 thiough line �
Total value (line 3 p�s line 7�
I hereby cenity the above is true. correci, and
complete.
'� �Ivino action - Sianature of Auditor
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52,000
TqUE TAX
(�)
(2)
(3)
(4)
(5)
(6)
1�)
(8)
Signawre of Assessor
ASSESSED
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STANDARD DEDUCTION
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3�7�
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Dare signed
Signature of Audim� (1 I Date Signetl �� I
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