Homestead_BuckCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION tfcio
State Form 5473 (Res / 403)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) 4-
I (We) occupied as our principal place of res ence the following described real property for which a
❑ 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
If buying on contract. Fee Simple owner's name
where contract is recorded
that on�the'1 st day of March, 20
Property Tax CreritA)derebl/y1 claimed:
roperty\or is buyiiq under a`contrOaU.
Record number I Page
P- ROP,ERLYDESCRIP.TION�:�.' eta-;?`. w_ �c`- ��.','�'��1.'w�''ia��i...E'�'.
County
Township
Testing district w hip)
Parcel number
-f
-00 / — �
Legal description
e9 P
Is the property in uesdon:
IQ Real property ❑ Mile Homo ( /.C. 6-1.1 -7)
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 utilized to produce income.
'�. - It r '" ,.• 'tP,ROP.ERTY:OWNED`.Bl! CLAIMANT -IN' THEWCOUNTIES &"�z?•,'' ir?, ? r- - 'r`f
County
Township
County Township
1 hereby certify the above statements are true, correct and complete.
Si nature of claimant ./
dress (number and street, city, state, Zip code)
iASSERUSE ONLY i4'z¢'
:xf.tL• .7j„+a+ �!},'p _ScigH A- iya*n��,{ ., ;'4�
r TRUE;TAX�
zVAL UE,�F .
ASSESSED.VALUE
5`ATa100%OF TTVv
`v'.HOMESTFJID '
}? _VALUExy
° NO ESIDENTIAL n
Land not exceeding 1 (one) acre immediately'°""r
1
Signature of Auditor
Dale signed
+
surrounding residential improvements.
O
Other land
Total land (line 1 plus line 2)
(3)
Dwelling
(4)`ns'
Aetrrty"c2 --.
Residential improvements or Annually
Assessed Mobile / Manufactured Home
Garage
5
A-1101MEN ;. Moil-
Other improvements
(5)
y>3SW n'`
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(d)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Dale signed
F' `'"pitzi-W -ME fi.. - "'x`." t`+ 4�`£- x-n.±? tar ».s �' '` -iY,' STANDA RD, DEDUCTION'ALCOWAHCE:L.'`.`
20 _ Pay 20
Lesser of 112 Homestead
Valuation or E35.000
$
Signature of Auditor
Dale signed