Homestead_BuyherCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
FORM
YEAR
1 jv :CERTIFICATION. STATEMENT„-,'-.
s0c20—
(Iww:)) occupi a our principal place of neonce the following described real property for which a Homes Pd PIOLCEdit liamned
a Te
-F1 I(We)owned Are buying under contract
49 lave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pW I js0QQQ 5nde, , contract.
If buying on contract, Fee Simple cromer's name
Recorder's office where Contract is recorded
AUDITOR
Record number I Page
DESCRIPTION
County
Township
A
County Township
Taxing district (cdy, tom, township)
I
Parcel number
L dVon
Signature of Auditor
Is the property In question:
0 16 n b
10�
I MkQ
I ❑ Real property ❑ Mobile Home (/.C, 6.1.1-7)
If any portion of the residential structure or the [arid not exceredin
(1) am that immediately surrounds that structure is used to produce Income, describe the use and portion
of the property utilized to produce income.
,V;�-� z,..-ePROPEf(T,Yi'owNED�,i3y,cLmMANT'IW.'OTHEFt'tCiUNTIES�ll;�lis,V-��+�x'�
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County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
(number and street, city, state, ZIP code)
4P�:-f,;y STANDARD DEDUCT10WAILLOWANCE. -
20 _ Pay 20
53ggdE-6.14E6&
fiik
HOMESTEAD .r
--NON-RESIDENTIA0
Valuation or 535,000
$
Signature of Auditor
I Date signed
vo–CLT
V
Land not exceeding 1 (one) acre immediately
J;
surrounding residential Improvements.
"!N
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Garage
.?*t improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed ail
complete.
Verifying action - Signature of Auditor
Date signed
4P�:-f,;y STANDARD DEDUCT10WAILLOWANCE. -
20 _ Pay 20
Lesser of 12 Homestead
Valuation or 535,000
$
Signature of Auditor
I Date signed
vo–CLT
ki V