Homestead_Umplebye;/�-'`' g CLAIM FOR HOMESTEAD PROPERTY TAX
i��� CREDIT/STANDARD DEDUCTION
�.` �� State.Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side Ior7iling instructions.
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I(we) _ / Y�n� �M__ LS,/_}(j� / wLj at th st day M , 19_
I(We) occ ie as our principal place of residence the following describ real property for whi a H, by Uaimed:
r,�.a 1 n�,!,TV AUDITOR
❑ I(We) o ned ❑ Are buying under contract
❑ Have a beneficial interesi in ihe entity that is liable for ihe property taxes on the property and ihat owns ihe property or is buyin9 under a contract.
� • � CONTRACTRECORDED - - � � -
I( buyirg on contracl, Fee Simple owner's name
Recorder's oflice where contract is recorded Recortl number Page
- - ' PROPERTY DESCRIPTION � � �
Counry Township Tazirg disvip (ory, fown, township) �
Parcel number Leqal description i
� 36 �
If any portion ot the residential svucture or the land not exceeding one (7 � acre that immediatey surmunds a[ swaure is usetl to produce income, describe the use arW ponion
of Ne property utilized to produce income. ,
' . � PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
••ty Township Counry Township
I hereby certify ihe above statements are true, correct and complete. i9nac re claim �
Adtlress (number and slreet ciry. state. ZIP ootle)
a ' o
ASSESSOR USE ONLY . TRUE TAX ASSESSED HOMESTEAD� � NON-RESIDENTIAL
VAWE VALUE VALUE . VALUE -�
Land not exceeding t(one) acre immediateiy .
surroundingresidentialimprovements. (�)
Oiherland (p) . -
Total land Qine 7 pWs line 2� (3)
Dwelling � (4)
Residen�ial improvements .
Garage (5�
Other improvemenis (6) � �
Total improvemenis (line 4 through line � (7)
Total value (line 3 p�s line � � (g)
' by Certi(y lhe above is lrue, correCt, and Signamre ot Asseswr Date signetl
�,ete.
Verityirg action - Sgnature of Autliror Date signed
STANDARD DEDUCTION
19_Pay19_
�esser of 1l2 Homestead
Valuation or 52.000
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Date
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