Homestead_DavisCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R215-92)
INSTRUCTIONS See reverse side for filing instructions.
FOiM
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I ' YEAR I
_ CERTIFICATION STATEMENT
.Na) t certify that on the 1 st day of March, 19_
1 (We) occupied as our principal p ace of residence the following described real pro rty for which a Homestead Property Tax Credit is hereby claimed:
(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 burying 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
1 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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
ereby certify the above statements are true, correct and complete.
- tureo ant
Address (number and street, city, state, ZIP cod)
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTE
NON- RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Other land
(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)
I 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 iLz
Date signed
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