HomeMy WebLinkAboutHomestead_Ward (4)d�� �'"�` t CLAIM FOR HOMESTEAD PROPERTY TAX
�� CREDIT/STANDARD DEDUCTION
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�• State Fortn 5473 (RZ / S92)
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INSTRUCTIONS: See reverse side lor tiling instructions.
FORM YEAR
HC10 °
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CERTIFICATION STATEMENT
I(We)�I�.l �y2y,�,� �. L ��l.C'�p . c ify that �tst ay of M , _
I(We) occupied as our principal plg.e of residence the following described real properry for which a Homesi f �_, is 1 imed:
❑ I(We) owned ❑ Are buying under contract �
❑ Have a beneficial interest in the entiry that is liable for the property tazes on the property and that owns the property or is buying under a contract.
CONTRACTRECORDED
Ii buying on conVact, Fee Simple owners name '
Recorders offce where conVact is recorded ' Fiecord number Page
PROPERTY DESCRIPTION �
Counry � Township Taning tlisMa (ciry, fown, rownship) � -
Pa�e�l Ibe 3 1— J� Legal descrip l� C/ �— I � C/� �-+ i 1� �
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If any poNOn of ihe residen6al strucWre or Ne lantl not exce ding one (7) acre Nat immediatety surtounds that sVUtture is used m protluce income, tlescnbe the use and ponion of
ihe propery utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
. Signature of Gaimant
iereby ceRiry the above statements are We, correct and complete.
ddress(numberalMSlreetc� stare,Z/Pcode)
a s.
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding t(one) acre immediatety (��
surrounding residential improvements.
Oiherland (2)
Totalland (line 1 plusline 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvemenis (6)
Total improvements (line 4 Ihrough line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certi(y the above is true, correct, and signamre ot nssesor oate signea
complete.
Verifying ac6on - Signamre of Auditor Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead �
Valuation or S2,000
Signature ot Auditor Date signed