HomeMy WebLinkAboutHomestead_Schmidt (4)e� ^"3 ; CLAIM FOR HOMESTEAD PROPERTY TAX FOpM YEAR
3��= CREDIT/STANDARD DEDUCTION HCto
.. _�� .,,'� State Form Sa73 (R2 / 5-92)
�aTi - _ -
INSTRUCT/ONS: See reverse side lor7iling instmctions. - .
. � � CERTIFIC ION�STATEMENT � � -
' �� ' ;
�e) . certify ihai on the lst day of March, 19' ,
e) occupied as r principal place residence the following d cribed real pmperty for which a Homestead Pmperty Tax �� islh r�6y'.dalmed:
❑ I(We) owned ❑ Are buying under contraci , . . .
❑ Have a beneticial interest in the entity that is liable tor the property taxes on the property and that owns the property dLis 6uyjng u'rider$co�V�ct.
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- CONTRACT RECORDED ` ��
It buyirg on tontracL Fee Simple owner's name - .
Recorder's oNice where ntract is recorded , Record number Page
- � � 05
' PROPERTY DESCRIPTION � -
Caunry . - TownsNp . - . Tvcing district (ciry, mwn, rownship) � -
Parcel n ber Legal description
o �'-oa q3-o v g
If any portion of the residential stmcture or the lantl not exceeding one (1) aae that immediatey sunounds that structure is usetl to protluce income, describe ihe use and portion
of Ne propeny utiiized to protluce income.
PROPERTV OWNED BY CLAIMANT IN OTHER COUN'fIES ��
Counry Township Counry Towns�ip
�reby certify the above statements are true, correci and complete. Signamre ai ani
Address (number arM street dry. state, ZIP wde)
ASSESSOR USE ONLY � TRUE TA7( � ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land noi exceeding 1 �one) acre immediately
surrounding residential improvements. (�)
Other land (p)
Total land (line 7 plus line 2� (3)
Dwelling (4) . �
Residential improvements
Garage (5)
Other improvements (6) . .
Total improvements (line 4 th�ough line � (7)
Total value (line 3 p�s line 7� (g)
I hereby Certify the above i5 Irue, Correcl, and Signawre of Assessor Date signed
camplete.
"ying aciion - Signa:ure of Audiror Date signed
ALLOWANCE
19 Pay 19 _ I
Lesser of 7/2 Homestead
Valuation or 52,000 S
Si9nature ol Autlim� ._ I Oale signed
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