HomeMy WebLinkAboutHomestead_Easterday`,`�*""°- CLAIM FOR HOMESTEAD PROPERTY TAX FoRM YEAR
; CREDIT/STANDARD DEDUCTION HC10 9'_i^ ��
��� ` State Form 5473 (R2 / S92) � �{ � � + j
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INSTRUCTIONS: See reverse side lor filing instruc[ions. _ �
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� CERTIFICATION STATEMENT . „ , n ,
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, e) Vi certifytha(.on�he�ist�dayof�March,cl9-a.��`
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I(We) occupied as our principal place of re ' ce the following descnbed real property for which a Homestead Pr per[y�Tax�6reifit is hereby'c`laimed: ��
I(We) owned ❑ Are buying under contract
Have a beneficial interest in the eniiry that is liable for the property ta�ces on the property and that owns the property or is buying under a contract.
� � CONTRACT RECORDED � -�
If buying on wnvact, Fee Simple owners name
Recortlers office where comrnct is recorded �. . Fecord number Page
PROPERTY DESCRIPTION � - ��
Counry � Township ' T' g dis�(icl (cify, lown, township)
Parcel number q Legal descnption
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If any portion of Ne resitlential swcture or ihe land not exceeding one (t ) acre that immediatety sunounds ihai struMUre is usetl ro protluce income, tlescribe Ne use and portion of
the pmperty ulilized to produce income. �
PROPERTY OWNED BY CLAIMANT.IN OTHER COUNTRIES �
Counry Township Counry Township
SignaWreo aim
�ereby certlfy the above statements are true, correct and complete. � �
Address (number antl s1reeG ciry, state, ZIP code) - -
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ASSESSOR USE ONLY TRUE T X ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE _ �VALUE VALUE
Land not ezceeding 7(one) acre immediately (�)
surrounding residential improvements.
Oiherland � (2)
Total land (line 1 plus line 2) (3)
� Dwelling (4) � .
Residential improvemenis -
Garage (5)
Other improvements (6)
Total improvements (line 4 through line 6J (7) -
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, correct, and Signamre of Assewr Date signetl
complete.
Ventying ac6on - Signature of Auditor Date signetl
STANDARD DEDUCTION ALLOWANCE
79_ Pay 19 _
Lesser of 1/2 Homestead S
Valuation or 52,000
Signature of Auditor - Date signetl
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