HomeMy WebLinkAboutHomestead_Smith (59)4�[����!
e�/ °' g CLAIM FOR HOMESTEAD PROPERTY TAX
;��� CREDIT/STANDARD DEDUCTION
�,�� State Fortn 5473 (R2/ 5�92)
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INSTRUCTIONS: See reverse side !or /iling instructions.
FORM YEAR
HC10
- .. .������
I(we) � W YV�L�T� . cenify Jtny� on tne ist day o arch, t9_
:ea.occupied as our principal p c of residence ihe following described real property for which a Homesiead qrpperty Tau Cr it ereby � im
�, I (We) owned ❑ Are buying under coniract - , '`f �- - „ ,,�
/,: �. _. _ = C�:;s: r . iptTOR
❑ Have a beneticial interest in the entity ihat is liable for ihe property taxes on the property and thai owns ihe property or is buying under a contract.
� �CONTRACTRECORDED � -
II buying on contracLFee Simple owner's name . . � . � , - ' - �
Recorder's oHice where contract is recortletl Record number Page
PROPERTY
TownShip
r , ^,� Legal description
% �����d—W L� ' -�
oi the residential struciure or the land not exceeding one (7 � acre that
y ufilized to produce income.
town, townsnpZ =•
fely surrounds Ihat structure is used to produce income, describe the use antl portion
ASSESSOR USE ONLY � TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VA�UE VALUE VALUE
land not exceeding 1(one) acre immediately "
surrounding resideniial improvements. (� %
Oiherland (p)
Total land (line 7 plus line Z�
Residential improvements
Other impmvements
(3)
Dwelling (4)
Garage (g)
(6)
Total improvements (line 4 through lina �
Total value (line 3 p�s line 7�
I hereby certify ihe above is true, correci. and
complete.
Verityin�action - Signa:ure ol Auditor
f���. 19_Pay79_
/ • � Lesser ot tl2 Homestead
Valuation or S2.000
` �,� , n
(�)
(8)
Signawre ot Asseswr
STANDARD DEDUCTION
3
Date siqned
Date signed
Da;e s�
/