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CLAIM FOR HOMESTEAD PROPERTY TAX M M YEAR
CREDIT /STANDARD DEDUCTION
State Form 5473 (R5110-01) 1
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions. A, -
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certify Qdt�.o8�,'dyl' March, 20
upied as our principal place of a5sidence the following described real property for which a Homestead PropertNw,, b ai
01
I owned jo Are buying under contract '0
OR
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.
ONTRACT!RECORDED
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
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Counr
Township
Toeing dis ct (aly, town, townqp)
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Parcel number
Legal description Is the property in question:
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If my portion of the residential structure or the land not exceeding we (1) acre that immediately surrounds that s2u2l. is used tlpmd.�Pincome, describe the use and portion
Of the property utilized to produce income.
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County
Township
County Township
I hereby certify the above statements are true, correct and complete.
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ASSESSORUSE
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Land not exceeding 1 (one) acre immediately
surrounding residential Improvements.
EV,
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
RE
SRE
Other improvements
(6)
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Total improvements (line 4 through line 6)
(7)
Total value (fine 3 pits line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
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Verifying action - Signature of Auditor
Date signed
LOWANCE�'
20 Pay 20
Lesser of 1/2 Homestead
Valuation or $6,000 $
Signature of Auditor Date signed
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