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e�/ =' � CLAIM FOR HOMESTEAD PROPERTY TAX
�r�� CREDIT/STANDARD DEDUCTION
,��: � State Form 5473 (R2 / 5-92)
4is
INSTRUCTIONS: See reve�se side 7or /iling instructions.
14We) C��LJ�_I� � � ' CI I� )�l
�a) occupied as our principa lace of residence ihe followin scribed real property
L� I(We) owned ❑ Are buying under contraci �
❑ Have a beneficial interest in the entiry ihat is liable for the pwperty taxes on the properiy
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���rtify thai on the Ts('d�� Qt4+A&rMiRl9�
n �a �om/es ad Prope y 7a�c Credii is hereby claimed:
f that owns the property or is buying under a crontract.
. � � � - . CONTRACTRECORDED � - , � .
It buying on contrat�, Fee Simple owner's name , � . - . . . . � .
Recorder's oflice where coniract is recortled Record number Page
, ,
Counry � , Township
P��� {{{rcel � mber /�-/� Legal de<
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I( any ponion of �he residential swcmre or ihe land not
of Ihe pwperty utilizetl m protluce inmme.
PROPERTY DESCRIPTION
one 17) aae
(awn.
C '
structure is used ro produce income, describe Ne use and portion
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL
VALUE VALUE VAIUE VALUE
Land not exceeding 1(one) acre immediately . � '
surrounding residential improvements. (�)
Otherland (Z)
Total land (line 7 plus line Z� (3)
- Dwelling (4)
Residential improvements
Garage (g)
Other improvements (6)
7otal improvemenis (line a through lina � (7)
Total value (line 3 pLs line � (g)
I hereby Certi�y Ihe abOVe i5 irue, cOrreCt. and Signature oi Asseswr Date signed
complete.
Veritying action - Signature of Auditor Date signetl
��
19_Payt9_
Lesser of 7/2 Homestead
valuation or 52.000
STANDARD DEDUCTION
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Date signetl .
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