Homestead_Young (17)� CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
� � Sta�e Form 5473 (R6 / 403)
Prescnbed by the Oepartment o1 Local Govemment Financ�
INSTRUCTIONS: See revc/sc side !or /ilinq insin�r.fions.
�
FORM YEAR
C 0
I(We) 1 certi(y lhatdff tMEiS71 arch, 20_
I(We) ccupied as our principal place of residence t e ollowing descn ed real property for which a Homestea�����'F i� �y�laimed:
❑ e) owned ❑ fve buying under contracl
� Have a benefidal interesl in the entity that is liable for the property taxes on the property and Ihat owns the property or is buying untler a contract.
`c'`u-t .y.nx�c,a:t'>;•t .r7'.�:-.E�; � . ...;e-�;. `�..< ��� CONTRACT<RECORDED['�' f �- - � " - ..- .. � .
If buying on contract, Fee Simple owners name
Recorders ofice whera wntrad is rewrded
Remranumber �Page
i'+r`,T' `� ii.i�'�'�- •' --" : . �:FROPERTY DESCRIFTION'�-. - .,,.. . . - .. . - =
County Township Ta�ing tlistrict (tity, town. fownshiP)
Parcel number Legal descnptlon Q j Is Ne Oroperty in lion:
� � -� � ' eal pmperty ❑ Mobile Homa (I.G G7.1-0)
If any portion ot ihe residentlal swcwre w lhe Wnd nW exceeding one (1) acre hat imme0iatety sunounds ihai swcture is use0 to produce income, desriibe the use anC portion
of the properry utilized to praduce iriwme.
rY"' `�� �r / ;� � - " � � � - � TRUETAX ASSESSED VALUE ' HOMESTEAD � NON-RESIDENTIAC;,. �
,sa� �yj t�; }ASSESSORUSEON Y,. __ . yqLUE AT100%OF.TTV- VALUE �-:=i,yq�UE;�
Land not exceeding 1(one) acre immediatety --: - -- _-
surtounding residential improvements. (� � . ' ' - �
Oiherland (p) �
TUaI land (line 1 plus line 2) �3) I
Dwellin9 (4) . �� ..Li�:;,..._ -. .�_. ,_
s : r
ResidenUel improvemants or Annually I � .F. ,f
Pssessed Mobile I Manufactured Home Gara9e (5)
Other improvements (6)
Tdal improvements (line 4 throvgh line 6) ��� I
Tctal value (line 3 plcs line � (g)
I hereby certify the above is W e, cortecl, and Signamre of Assessor Date signed
complele.
Vaifying aclion - SignaWre of Fwtlitor Date sgned
3rAp_:�- � r' -:'?� � =�-�STAN�ARDDEDUCTIONALLOWANCE - � ''�'�� � - � '
20 _ Pay 20
Lesser of 1/2 Homes;ead
vruauon or E35.000
5
Signalure olAUditor ' I Datc si9ned