HomeMy WebLinkAboutHomestead_Derscha°% -�°, CLAIM FOR HOMESTEAD PROPERTY TAX
. CREDIT/ST�.NDARD DEDUCTION
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�'� � State Form 5473 (R2 / 5-92) .
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INSTRUCTIONS: See reverse side lor filing instructions.
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FORM YEAR
HC70
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t(We) ' V - .� t�i the 7st y of March, 79
�e) occupied as our principal place of re ence the follovn g scribed real pro �for which a Homes d Property T x it is h y imed
I(We) owned .❑ Are buying under coniract _ ��„i� r; i�,7v e,!inITOR
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❑ Have a beneficial interest in ihe entity ihat is liable for ihe property taxes on the pmperty and that owns the property or is buying under a contract.
�� , � � - � " CONTRACTRECORDED ' - �
( It bupng on contract, Fee Simple owner's name �
Recorder's ottice where contract is recortletl Record number Page
Counry � Township '
Parcel nu ber�o I^� /,/ Legal tlescription
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I1 any portion ot the residential structure or the land not exceedinq one (7) acre that
of Ne property utilized to produce income.
County
Address
Township
certify the above siatements are true, correci and complete.
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ASSESSOR USE ONLY - �
Land nm exceediog 1(one) acre immediately
surrounding residential improvemenis.
Otherland
Tolal land (line 7 plus line Z)
Dwelling
Residential improvemenis
Garage
Other impmvements
Tolal improvemenis (line 4 through line 6j
Total value (line 3 p�s line �
I hereby cenify the above is true, correct, and
complete.
Veritying action - Sgnature of Auditor
SignaWre of
' L
19_Pay79_
Lesser of 1/2 Homestead
Valuation or $2.000
BY
(�)
(2)
(3)
(4)
(5)
(6)
l�l
18)
SignaWre of Assessor
5
L`
ASSESSED
VALUE
fown,
is used to produce
HOMESTEAD
VALUE
describe Ne use and
NON-RESIDENTIAL
VALUE
Date signed
Date signed
Date signed
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