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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R2 / 5-92)
INSTRUCTIONS: See �everse side lor filing instructions.
- � ��,�y ':. " , _YEAR
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MAY 21 1999
�� CERTIFICATION STATEMENT `
I(VJe) � U tt2r�i tlie`�§t�day df�irefcnRl _
I(We) occupied as our principal lace of residence Ihe foilowing described real prop tor which a Hom ad Property Tax Credit is hereby claimed:
�L!!.� (We) owned �- ❑ Are buying under contract �
1 tY P P rtY P P rtY P P hY �Y 9
LJ Have a beneficial interest in the enli that is liable for the ro e taues on the ro e and that owns the ro e or is b in under a contract.
CONTRACT RECORDED �
If buying on conVacl. Fee Simde owners name
Recortlers oftice where convact is recorded . Record numDer Page.
PROPERTY DESCRIPTION �
Counry Township T" district (ciry, lawn, fowns i 1
Parcel number `I Legal tlescription
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If any portion of Ne residential structure or the land not exceeding one (7 ) acre that immediatety surrounds ihat swc[ure is used to produce inwme, descriDe Ne use antl portion of
Ne properry utilized ro pratluce income.
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township ' Counly Township
Sgna[ure ot claimani
��reby certify the above statements are true, correct and complete. � U� s
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Address (number and streeC ciry, s(a(e, ZIP oode) �
O ' r, ;ve�i`o�r/ � 76�a
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately �� �
surrounding resideniial improvements.
Otherland (2) � -
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvemenis (line 4 through line 6J (7)
Total value (line 3 plus line 7J (8)
I hereby certi(y the above is true, tOneCl, and Sgnawre of Assemr Date signed
complete.
Veriying action - Sigrature of Auditor Date signed
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•, STANDARD DEDUCTION ALLOWANCE �
79_ Pay 19 _
Lesser of 1/2 Homestead �
Valuation or S2,000
SignaNre of Autliror . Date signed
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