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a' 4 CLAIM FOR HOMESTEAD PROPERTY�TAX
,��'� CREDIT/STANDARD DEDUCTION
' State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side !or 7iling instrucfions.
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���Ne) �� " �,1g � CQUS" �'v� A�P.�rbh. 19_
) occupi d as our principa place of residence the followinq descr d r I prope or which a Homesf�ad ropertyTaz Credit is hereby daimed:
I(We) owned ❑ Are buyinq under contract
❑ Have a beneficial inierest in the entiry ihat is liable for ihe propeny taxes on the pmperty and ihat owns ihe property or is buying under a mntract.
� CONTRACT RECORDED � �� � � � .. -
It buying on coniract, Fee Simple owner's name - � ' � ' ' . ' , �
Recorder's ottice where wntract is remrtled Recortl number Pa9e
County
� - PROPERTY DESCRIPTION
Township - - � . Tarinatlistrici (ciry, town, 7ownship)
Parcel number Legal description �
b� Q' ���6�1 ti- oC� .
It any ponion of ihe residential struaure or the Wnd noi exceeding one (7) acre that immediately surrountls Mat structure is used ro produce income, describe Ne use aM portion
of the property utilized to produce inwme.
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ASSESSOR USE ONLY . TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE -
Land not exceeding 7(one) acre immediatety .
surmunding residential improvements. (�� �
Other land (p)
Totai land (line 7 plus line 2� . g I
11
Dwelling (4) . " -
Resideniial improvemenis
Garage (5) ;
Oiher improvements (6)
Total improvemen[s (line 4 through line � (7)
Total value (line 3 p�s line � (g) �
I hereby tertify the above (5 Uue, corrett, and Signamre ot Assessor Date signed
complete. "
'-"virg action - Sgnature of Audibr Date signed
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19_Pay19_
Lesser ot 1l2 Homestead
Valuation or 52.000
STANDARD DEDUCTION
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Sgnature ot Autlimr ✓ � t \ ^ n . n_^ I Dare signetl
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