HomeMy WebLinkAboutHomestead_Pohle� ^'� 4 CLAIM FOR HOMESTEAD PROPERTY TAX l �FORM� ��I� II F YEAR
��,.d
; ;; CREDIT/STANDARD DEDUCTION - Hcio
. �• State Fortn 5473 (R2 / 5-92) . � . � ' [�tl i nC
uo � . ' . ' 4T'7'1 J.7 . .
INSTRUCTIONS: See reverse side lor filing instructions.
�) - . l.l- ,�y�t.,.trS '
- ' � - � � �CERTIFICATIONSTATEMENT ' ' w��""� �� �SCiR �
I IWe) �certify ihat on�the 7st day of March, 19_
�6) occupied as our principal place of residenc t e tollowing described real.property for which a Homestead Property Tax Credit is hereby daimed:
I (We) owned ❑ A�e buying under contract . .
LJ Have a beneticial interest in the entity that is Iiable for the property taxes on the property and ihat owns the pmperty or is buying under a contract.
� � CONTRACTRECORDED � ' -
It buying on coniracL Fee Simple ownefs name � _ .
Recortler's oHice where coniraa is recorded Record number Page
Counry
Parcel number
tl any portion 0� Ihe re5id
ol the pmperty utilized to
Township
structure or the
ce income.
DESCRIPTION
TaziGd'dislria (ciry, fown. lownship)
LJ1� �
.�x Y�.c. �i- . i
surmuntls that strucmre is used ro produce i�ome, describe the use aM
ASSESSOR USE ONLY - TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VAIUE VALUE
Land not exceeding 7(one) acre immediately
surrounding residential improvemenis. (�) �
Oiherland (p)
Total land (line 7 plus line 2� (3)
Dwelling (4)
Residential improvements
Garage (5) �
Oiher improvements (6) �
Total improvemenis (line 4 through lina � (7)
Total value (line 3 p�s line 7� (g)
I hereby certify the above is Irue, correct, and Signamre of Assessor oare signed
complete.
Verirying action - Signature of Audimr Date signed
� STANDARD DEDUCTION ALIOWANCE .
79_Pay79_
Lesser of 7/2 Homestead
Valuation or 32,000 S
Sig W ol Auditor Date 5ign2tl
" S