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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/ 592) -
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INSTRUCTIONS: See reverse side for filing instructions.
W. •
- CERTIFICATION STATEMENT -j'.
I (We) _ fd' ay of March, 19
I (We) occupied as our principal place of re d nce the following described real property for which a Homeste petty ax Credit is hereby claimed:
.I (We) owned .� -Are buying under contract
®lave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED
If buying on contract, Fee Simple owner's name - - -
Recorders office where contract is recorded Record number Page
- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
- PROPERTY DESCRIPTION -
County r-
Town hip
Taxing dislr
t (city, town, township) -
Parcel number
Legal description
O
, .
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
Total land (line I plus line Z)
(3)
- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County -_
Township
I hereby certify the above bove statements are true, correct and complete.
Signatur tlai ant
ess (number and street, city, state. ZIP code)
- 100_.[3'x_,23_ rwmlc -fCO I . 7dS/
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON-RESIDENTIAL
- VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Signature of Auditor
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Other land
(2)
Total land (line I plus line Z)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
-
-
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pfrs line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 1/2 Homestead
$
Valuation or $2,000
Signature of Auditor
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p .
Date signed
_I _