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Homestead_BoyleCLAIM FOR HOMESTEAD PROPERTY TAX F R YEAR s' CREDIT /STANDARD DEDUCTION HC1 I' State Form 5473 (R2 / 5 -92) INSTRUCTIONS: See reverse side for filing instructions. CFRTIFICCTION STATFMFNT I (We) L,¢,gyV c�L certify that on the 1st day of March, 19 occupied our rincipal place of residence t e following described real property for which a Homestead Property Tax Credit is hereby claimed: I (We) owned El 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) - Parcel number Legal description (, - 41 • If 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 utlfized to produce income. PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES County Township County Township by certify the above statements are true, correct and complete. SignaturpAt claimant Nom') Address (number and street, city. state, ZIP code) V0,167 ©/f `\ ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL VALUE Land not exceeding 1 (one) acre immediately surrounding residential improvements. (1) Signature of Auditor `\ - Otherland (2) — Total land (line 1 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 pl/s line 7) (6) I hereby certify the above is true, correct, and complete. Signature of Assessor - Date signed Ventyirg action - Signature of Auditor Date signed - STANDARD DEDUCTION ALLOWANCE - 19_ Pay 19_ Lesser of 1/2 Homestead Valuation or $2,000 S Signature of Auditor `\ Date signed r V —