HomeMy WebLinkAboutHomestead_BurnseE i CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (132 / 5 -92)
4b
INSTRUCTIONS: See reverse side for filing instructions.
-110 yl�S
1D 0
e) W- _ Gl/..Z. Y % T I (..r.-Ll. LY (j (71_[_ UYL/.J/ certify that on the 1st day of March, 19�
1occupied as our principa (Piece of reFd , M a �m- r�u�wu.g oencn ah aTf7RIL9T�Romestead Property Tax Credit is hereby claimed:
(We) owned ❑ Are buying under contract -
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED
II buying on contract, Fee Simple owner's name - -
Recorder's office where contract is recorded Record number Page
` PROPERTY DESCRIPTION
County
Tow . hip
Taxing district (city, town, township) -
Par number
-
Legal desaipno
f PESu) . 13 -2 -9 1 . 3-7 Q-C
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. _
O)� -13 -I "� -moo ool• 5O° -Ooze
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
certify the above statements are true, correct and complete. Y 7r are of
(number and street, city. state. ZIP code) 01 /L• \J `/I
41 Be�G$6G O�Fccar/D [Irv, /x147660
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
_
Other land
(2)
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pUs line 7)
(g)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
g action - Signature of Auditor
Date signed
19_Pay 19_
Lesser of 1/2 Homestead
Valuation or $2,000
of Auditor
STANDARD DEDUCTION
S