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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 547 3(R2/5-92)
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INSTRUCTIONS: See reverse side for filing instructions.
HC70
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le) _� / A rljy\ _ } Ley V - certify that on the 1st day of March, 1
e) occupied as; our principal ce residence the ollowmg d,, Ur bed real p p rty for which a Homestead Property Tax Credit is hereby G
❑ 1 (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 propeFrNi1lullng uflfaFi
CONTRACT RECORDED ,
If buying on contract, Fee Simple or 's na ^^mnnenn
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Recorder's office where contract is recorded Re
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
TRUE TAX
VALUE
PROPERTY DESCRIPTION
County
NON - RESIDENTIAL
VALUE
Township
eby certify the above statements are true. correct and complete. Signature of claimant
Taxing dis pct Iy wn, townshi
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6 W - 5) er — ^ ,^`rl
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Legal description
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It any portion of the rre�siid`eeential 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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
TRUE TAX
VALUE
Funry Township County Township
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
eby certify the above statements are true. correct and complete. Signature of claimant
A3:r- Z,w mber and street, dry. state. ZIP aide) f
( 8X X- /" rno.�e aer Gib ..9n .
5
iix
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
5
Otherland
(2)
Signature of Auditor
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 plrs line 7)
(S)
I hereby certify the above is true, Correct, and
complete.
Signature of Assessor
Date signed
0' action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 1/2 Homestead
5
Valuation or $2,000
Signature of Auditor