Homestead_CarrCLAIM FOR HOMESTEAD PROPERTY TAX
e CREDIT /STANDARD DEDUCTION
r State Form 5473 (R215-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
1 c
Aft o 2000
.. CERTIFICATION STATEMENT
I (We) 9I' — • . ceriify thafoii.ttte� sLday Ma i, 19_
I (Wp) oc upied as our principal place of residence the following describ real property for which a Homestead Property Tax Credif!sere claimed:
I (We) owned ❑ Are buying under contract
7
❑ 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
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township
Taring disMc "ry, town, township)
Parcel number
Legal description
-O C T
any ponian of the residential structure or the land not exceeding one (1) acre that immediately surr6ft that structure is used t4rodlice income, describe the nd portion of
the property utilized to produce income. "
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
n ure of cla
areby certify the above statements are true, correct and complete.
Address (number and street, city, state. ZIP rode) IV
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Otherland
(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
�j STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead S
Valuation or $2,000
Signature of Auditor
Date signed