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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5-92)
IN CTIONS: See reverse side for (ling instructions.
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APR 0 3
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YEAR
CERTIFICATION STATEMENT
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1 (We) certify that on the 1 st day of March, 19_
xcupie as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
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I (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
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County _
Township
Taxing district (ci9(,.Jown for hipJ
Parcelpumber
Legal description
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If any portion of the residential structure or the land not exceeding one (1) acre that immediatey, surrounds 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
Signature of dai
.lereby certify the above statements are true, correct and complete.
Address (number and street, d rate, ZlP code) L
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
ASSESSOR USE ONLY
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
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
$
Valuation or $2,000
Signature of Auditor
Date si ned