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e�/ °° � CLAIM FOR HOMESTEAD PROPERTY TAX .
z��= CREDIT/STANDARD DEDUCTION
.�,%�� Slate Porm 5473 (R2/5-92)
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INSTRUCTIONS: See ieverse side lor filing inshuc(ions.
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e) _ _ . � -• - certify that on the 7 si day of March, 19�
a) occupied as our pri ipal place of residence the following described realproperiy for which a Homestead Propehy Tax Credit is hereby claimed:
I(We) owned ❑ Are buying under con�ract . . . . �
Have a beneficial interesi in the entity that is liable for ihe property taxes on the property and thai owns ihe property or is buying under a contract.
- - . CONTRACTRECORDED - •
If buyirg on contract, Pee Simple owners name . . _ . _ . � � _ �
Recorder's oftice where contract is recorded , Aecord number Page
Counry
Parcel number
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tl any portion ot the resitlential
af the property utilized m prodi
or the IanC not
PROPERTY DESCRI
• _ �Taxing tlistrict
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one (7) acre that immediatety sunounc
is used to produce income, describe the use arW portion
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PHOPERTY OWNED BY CWMANT IN OTHER COUNTIES
Counry Township Counry Tmvnship
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� eby�certify the above statemenis are Ime, correci and complete. Si n.,, e o� ciaimant �
Atltlress (number arrd streeC `. slate, ZIP code)
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ASSESSOR USE ONLY � TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land noi exceeding 7(one) acre immediately
surrounding residential improvements. (�) �
Oiherland (p)
Total land (line 7 plus line Z� I
(3) .
Dwelling (4)
Residential improvements
Garage (5)
Oiher improvements _ (6) -
Total improvements (line 4 throvgh line 6� (7) I
Total value (line 3 p�s line � (g)
I hereby certity ihe abOVe is trUe. CorreGt, and Sgnature of Assessor Date signed
complere. � �
�fying action - Signature ot Autlitor Dare signetl
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19_Pay19_
Lesser of 7/2 Homestead
Valuation or 52.000
STANDARD DEDUCTION ALLOWANCE
9
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