HomeMy WebLinkAboutHomestead_GrubbCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
i State Form 5473 (R2 / 5-92)
,s INSTRUCTIONS: See reverse side for tiling instructions.
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YEAR
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I (We) certify that rtthe 1st y,,''y�//l1ry1'r',,'",,1,''arch, 19_
feby
I (We) occupie s our prin place of residence the following descri6e'U reel property for which a estead Pr e)try�/_�.a�,c claimed:
❑ 1 (We) o - d Are buying under contract /:, �' - rGF 1
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and thaYowns the property or is buying under a contract.
CONTRACT RECORDED
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION -
Coun
Township Taxing distil c ,tor township)
Pargel -number 03 -04) ( 7
6It
Legal tlesc'
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.
-A?o" -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
hreby certify the above statements are true, correct and complete.
Si na re o
Q
A d (nurpt�q r and street, city, state, ZIP code)
K-)�'It, �oxZZIB GAIL \aa>
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assesor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
S
aluation or $2,000
Sig u
IA'udit r
Date
ZI
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