Homestead_BellCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (8215 -92)
INSTRUCTIONS: See reverse side for tiling instructions.
I)FORM
APP, a 2000
n
CERTIFICATION STATEMENT
I (We) certify that on the 1 st day of March, 19_
(We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
\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 property or is buying under a contract.
CONTRACT RECORDED _
It buying on contract, Fee Simple owner's name - -
Recorder's office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township) r
O
Parcel number
Legal description
O l!o - cy:� I44
- Cc
If any portion of the residential structure or the land not exceeding one (1) acre that immediately suaounds 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 COUNTRIES
County
Township
County
Township
Signatu of claiman
ereby certify the above statements are true, correct and complete.
Address (number and street, city, state, ZIP code)
121 ti.. t sue- (a Z "' 7660
ASSESSOR USE ONLY
TRUE TAX
_
ASfESSED
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
- 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
$
Valuation or $2,000
Signature of Auditor
Date signed
N- - a