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�" °. CLAIM FOR HOMESFEAD PROPERTY TAX
s��'� CREDIT/STANDARD DEDUCTION
.�.,;�� Sute Form 5n73 (R2 / 5-92)
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INSTRUCTIONS: See reve�se side Ior filing instructions.
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'e) _ �. �. certify that on the 1 st day of March, 19�
`e) occupie our principal place of residence the following described real pmperty for which a Homesiead Pmperty Tax Credit is hereby claimed:
I(We) owned ❑ Are buying under contract .
Have a beneficial interest in the entity that is liable for the property taxes on the property and ihat owns ihe property or is buying under a contract.
� CONTRACTHECORDED - �
If buying on coniract, Fee Simple owner's name �
ReCOrders Offite where tontract i5 recOrded Record number Page
County
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It any portion of
of the pmperty �
; . PROPERTY
�rye� uexnpuw�
- �IS 5
strucNre or the Wnd not ecceetling one (1 � aae ihat immediately
ice income.
PROPERTY OWNED BY CLAIMANT IN
Counry Township Couniy
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�eby certity the above siatements are irue, correct and complete. Signamre �
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Address (numberandsfreef, ury, sf^fe. ZlPmde)
tawrt.
ar -
ihat swcture is used to produce income, describe the use antl portion
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- ASSESSOR USE ONLY - TRUE TAX ASSESSED HOMESTEAD . NON-RESIDENTIAL
� VALUE VALUE VALUE VALUE
land noi exceeding t(one) acre immediately
surroundingresidentialimpmvemenis. (�) �
Oiher land (2)
Total land (line 7 plus line 2� (3�
Dwellin9 (4) -
Residen�ial improvemenis
Garage (5)
Other improvemenis (6)
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line � (g)
I hereby Certify the above i5 irue. correci, and Signanre ot Assessor Date signed
complete.
�ying aaion - Signawre of Autliror Dare signed
STANDARD DEDUCTION ALLOWANCE .
79_Pay19_
Lesser of 7/2 Homestead
Valuation or S2.000
of Autlitor \ � � � \
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