Homestead_Watkinsa• ^",. - '
e/ "°, CLAIM FOR HOMESTEAD PROPERTY TAX -
3?�': CREDIT/STANDARD DEDUCTION '
State Form 5473 (R2 / 5-92)
,-.�
INSTRUCTIONS: See reverse side lor /iling instructions.
STATEMENT
u ����
��y�FORM4 G YEAR
� C�O� �� �
- AUI3IT�R U
e) �t���Q � a�(�,��� �D. •. - certify. that on the 1 st day of March, 19_
`) occupie s our principal place of residence ihe following descritied real property for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned -❑ Are buying under contract - � � . , , �
Have a beneficial interest in the entity that is liable tor the property taxes on the property and that owns the property or is buying under a contract.;
� �� � � � �CONTRACTRECORDED��� � � '
It buying on contract, Fee Simple owner's name � _ ' . .
ReCOrder's office where conirad is recorded ReCOrd number Page
Counry
" - ' PROPERTY DESCRIP'T�ON � � ' �
Township � � 'TaY{nq dis�rit� (Gry: town, fownship)
I
Parcel number �j �j Legat tlescription
'J ( R � d. ]�� O . �JO •
I( any ponion of ihe residential simcwre or the land not eaceeding one (il aue that immediatey surrounds that structure is used ro produce income, describe Ne use arM portion
of the pwperry uWized ro produce income. ,. .
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
County Tawnship Counry Tawnship
by certify the above statements are true, correci and complete. Signa re i a mant
Address (numberarrdslBet, Ciry, stat , IPcotle) T
i � 67a
ASSESSOR USE ONLY . TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL-
VALUE VALUE VALUE VALUE
Land noi exceeding 1(one) acre immediately
surrounding resideniial improvemenis. (� % � - �
Oiherland (2)
Totalland (line ] plus line � (3)
Dwelling (4) � .
Fesidential improvements .
Garage (g) �
Other improvements (6)
Total improvements (line 4 Ihrough line � � (7)
Total value (line 3 p�s line � (g)
I hereby certify ihe above is Irue, correct, and Signature of Assessor Date signed
complete.
Vo�rying action - Signature ot Autlitor Date signed
19_Payt9_
Lesser of t/2 Homestead
Valuation or 52.000
Signature ol
STANDARD DEDUCTION ALLOWANCE
S
e
Date signetl
► 1-�l-9�