Homestead_Zeisler_ �
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e%^� CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
_ .s �a�: CREDITISTANDARD DEDUCTION HCto
"`��� Sta1e Porm 5473 (R2l 5-92)
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INSTRUCTIONS: See reverse side lor liling inslructions. �
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CERTIFICATIONSTATEMENT �(`.' ;�_ �� �)
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I(We) � nify Ihat on the 7st day of March. 19
i /Al�19 � ��JU�.
�) oc � ied as our principal place f esidence the following des r ed real properry for which a Homesiead Property Tax Credrt ishereby daimed:
�'17We) owned ❑ Are buying under contract �'�/
��Y�!naJ n�'iq. �{'i,r.i
L� Have a beneticial inlerest in the entity ihat is liable for the properry taaes on the property and that owns the property or is buying+U UI I V K vct:r'�
� CONTRACTRECORDED
If buying on Contra[L Fee Simple owner'S name
Recortler's oH%ce where conuaa is recortled Record number Page
Coun;y � Township � Ta.ing di5(ritt (city. fown mwn5hip)
Parce�l nu�mber Legal tlescription
S/S.J—(D7 /-CJ��4-oo P-� [...) N-..� /� a-JI l y��i� �
11 any portion of the residential stmcwre or the tand not e.ceedirg one ( t 1 acre that immed�a;ety surmunds that stmcmre is usetl m produce Income. tlescribe Ne use antl potlion
of the pmperty utilized �o produce Income.
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTIES
County Township County Township
by cenity the above statements are true, correct and complete. S�qnature ol �"manf/'� i ,_ ��
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�x �y„_,ii�
Address (numbe�ands�reec ciry. s�aie. ZlPCode) V •„"`���/•
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE . VALUE
ILand no� exceeding 1(one) acre immediarely I I I I
surrounding residen�ial improvemen�s. (�)
I Other land �
(2)
Total land (line 7 plus line Z� (3) ( I
Dwelling (a) I
Residential improvements
Garage (g)
O[her improvemeni5 I (6)
Total improvements (line 4(hrough line � (7) I I I
Toial value (line 3 pbs line 7� (g) I I
I hereby Certity the above is Vue, correCt. and I Signawre of Assessor I Da;e signetl
wmplete.
Verilying action � Signa;ure of Autlitor I Date sfgnetl
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19_Pay79_ �
Lesser of 7l2 Homestead I
Valuation or 52.000 S