Homestead_AtkinsonCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
�;•r! CREDIT /STANDARD DEDUCTION
(� Slate Form 54 7 3 1112 1 5 -92)
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INSTRUCTIONS: See reverse side for It g instructions. RRR
9
CERTIFICATION STATEMENT
i� I � iW.1 Tat day of March. 19
re ccupied as our principal place of residence the following described real property for which a Home Tax Credit is hereby claimed:
e) 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 properly or is buying under a contract.
CONTRACT RECORDED
It buying on contract. Fee Simple owner's name
Recorder's ollice where contract is recorded Record number Page
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PROPERTY DESCRIPTION -
County
Township
Sign re of claimant
Taxingn,11 (q . town. township)
)1
Parcel number
Legal escripPon
VALUE
OI l� -o d
Land not exceeding 1 (one) acre immediately
_uditor
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II any portion of the residential structure or the land not exceeding or6o
1 acre that immediately surrounds that structure is used to produce income. describe the use and portion
of the property utilized to produce income.
surrounding residential improvements.
':• ; ' ; PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Ccunly Township
County Township
a•reby certily the above statements are true. correct and complete.
Sign re of claimant
Address (number and srreel. city. stale. ZIP code)
'
1� !' _ ' `• "' -
ASSESSOR USE ONLY 4�.
TRUE TAX
ASSESSED
' HOMESTEAD
NON-RESIDENTIAL -
,
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
_uditor
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surrounding residential improvements.
11)
Other land
(2)
-i'
Total land (line I plus line Z)
(3)
Dwelling
(a)
Residential improvements
Garage
(5)
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..... �.;
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., l i
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Other improvements
(6)`I"-
°-
Total improvements (line a through line 6)
(T)
Total value (line 3plrs line i)
(6)
I hereby certify the above is true. correct. and
Signature of Assessor
Date signed
complete.
lying action Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE -
19 __Pay 19_
.
Lesser of 1/2 Homestead
$
Valuation or $2,000
Si alt=
Date signed q G
_uditor
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