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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
Sia�e Porm 5a73 (R2 / 5-92) - _
INSTRUCTIONS: See reverse side lor filing instructions.
FORM v, YEAR
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'•tWe) I y�' �% /V�/a_ certify thai o�n�th A(l�p�fparch, 19_
��) occupied as our principal place of resid ce e tollowing described real property for which a Homesiead Property Tax Credit is hereby claimed:
L� I(We) owned ❑ Are buying under coniract �
❑ Have a beneficial interesi in the entity ihat is liable for the property taxes on the property and thai owns the property or is buying under a contract.
CONTRACT RECORDED - �
If buying on contraci, Fee Simple owner's name,
Recortler's oHice where contrect is recordetl Record number Page
Caunry
.v�`i-
If any poriion i
of the pmpert�
Couniy
PROPERTY DESCRIPTION
Township � Ta<irg district (ary. town, township)
. Legal description
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stmcture or the lantl not exceeding one (t) acre that
ice inmme.
g�
:tur is used to produce i�ome, descnbe the use arW ponion
PROPERTV OWNED BY CLAIMANT IN OTHER�COUNTIES
Township County
� certify the above statements are irue, correct and comptete. I s ature o�
(numberandsbe�ary.srate,Z/Pcode� n � _
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding 7(one) acre immediately -
surrounding residential improvemenis. (�)
Otherland (2) .
Total land (line 7 plus line Z� (3)
Dwelling (4)
Residential improvements
Garage (5)
Oiher improvements (6)
Total improvements (line 4 through line 6j (7)
Total value (line 3 p�s line � (g)
I hereby Certi�y the above i5 irue, correCt, and Signa;ure ot Assessor Da:e signed
complete.
Verityirg action - SgnaWre of Auditor Date signed
�
79_Pay19_
Lesser of 1l2 Homestead
Valuation or 52.000
STANDARD DEDUCTION ALLOWANCE
5
e of Auditor �--���-1 ! l -Y�-"� !� I Date�1e
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