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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92)
INCTRI /CTIl1N0 Cuc rovarca cida /nr filinn incfmrfinnc
FORM YEAR
.... -. .. .f . . _�
_ - � AF'K _ =: 2000
� CERTIFICATION STATEMENT - -
n1� �Y'R� � (� n
I(We) ��dC . e i� � o ..�� ��;]! CG c� Q f r 1
I(We) occupied as our principal place of residence Ihe following described real property for which a Homestead P�Oper('yY�iQ�dHti's hare�ei ed:
(We) owned ❑ Are buying under contraci
Have a beneficial inierest in the entiry thai is liable for the property taxes on the property and that owns ihe property or is buying under a contract.
CONTRACTRECORDED
It buying on conVact, Fee Simple ownets name
Recordefs office where contract is recordetl Recortl number Page I
PROPERTY DESCRIPTION
Caunry Township T" districi (dty, tow�n, township) '
Parcel number legal tlesCription
O � � ��
If any po ' of Ne residential swcture or ihe land not exceeding one (7) acre Nat immeCiatety sunountls ihat structure is usetl to produce income, describe the use and portion of
the property ulilize0 to O�uce incame. �
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTRIES
Counry Township , Counry Township
SignaNre ai nt
,ereby certify the above statements are true, wrrect and complete. J
Address (num �and sfreet, �iry. slate, P code) � � -
. �.i
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(oneJ acre immediately (�)
surrounding residential improvements.
Other land (2)
Total land (line 1 plus line 2J (3)
Dwelling (4)
Residential improvements �
Garage (5) �
Oiher improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, correct, and Signature of Assesor Da[e signed .
complete.
Verilying accim - Signature of Auditor Date signed
'. STANDARD DEDUCTION ALLOWANCE
79_ Pay19_
Lesser of t/2 Homestead �
Valuation or $2,000
Signature oi A dit Date sign
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