HomeMy WebLinkAboutHomestead_Hackere,�•,, .
e.� ° a CLAIM FOR HOMESTEAD PROPERTY TAX
aa�'� CREDIT/STANDARD DEDUCTION _
,�;�'� State form 5a73 (R2 / S92)
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INSTRUCTIONS: See ieverse side forliling instmctions.
� • -� ' _ � CERTIFICATI
FORM YEAR
H�,o 9�
I�II. � n
I(We) �, � - � � �Ce�G�l,.y C' c�{b�day of March. 19_
.�cupied as our principal place resi ence the o owing�described real pro rty for whiGp a Homestea o e Tax,�redi{'s' hereby Gaimed:
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,_, I(We) owned ❑ Are buying under contract , , , , AUDITOR �
❑ Have a beneficial interesi in the_ entity that is liable for the property taxes on the property and ihat owns the property or is buying under a contract.
- CONTRACT RECORDED .
If Wying on contracL Fee Simple owner's name � - ,
Recorder's oHice where contract is recorded Recortl number Page
� ' PROPERTY DESCRIP'fION
County Township . Taairg tlistrict (ciry,
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Pareel number L I des ipti n
0�9 -�/�_s/-����,�� 7-2 io. a 9f�<
It any ponion of ihe residential simcture or the land not ezceetling one (1 � acre ihat immediate surrounds ihat
of the properry utilized ro produce income.
is used to protluce income, tlescribe the use and portion
� PHOPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Counry Township Couniy Township
� _
- •eby certify ihe above siatements are irue, wrrect and complete. Signawre of claiman� ✓
ACtlress (number and s1ree1. ury, s(ate. ZIP e) �
G
ASSESSOR USE ONLY . TRUETAX ASSESSED " HOMESTEAD NON-RESIDENTIAL.
� VALUE VALUE VALUE VALUE
land not ezceeding 7(one) acre immediately
surrounding residential improvements. " (�) .
Oiherland (2)
Total lantl (line 1 plus line 2� (3)
Dwelling (4)
Resideniial improvements � .
Garage (g) �
Other improvements (6) �
Totai improvements (line 4 through line � (7)
Total value (line 3 p�s line � (g)
I hereby Certify Ihe abOVe is IrUe, correc[, and Signamre of Assessor Date signed
complete.
tying aciion - Signature of Autlitor Date signetl