Homestead_DouganCLAIM FOR HOMESTEAD PROPERTY TAX
e CREDIT /STANDARD DEDUCTION
State Form 5473 (8215 -92)
INSTRUCTIONS: See reverse side for riling instructions.
FORM'
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CERTIFICAIRN STATEMENT
I (We) certify that (atheLlst day of March r19_
I (We) occupied as our principal pla a of residence the fallowing described real property fo hich a Homestead Property Tax Credit is hereby claimed:
❑ 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 (dry, town, township)
Parcel number
o 1 10-0000-r- (�o
Legal description
a
If any portion of the residential structure or the land not exceeding one (1) acre that immediately suffVhds 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
certify the above statements are true, correct
and complete.
Si
claimant
Address (number and street, city, state, ZIP code)
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
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
complete.
Signature of Assesor
Date signed
Verifying action - Signature of Auditor
Date signed
19_ Pay 19
Lesser of 1/2 Homestead
Valuation or $2,000
STANDARD DEDUCTION ALLOWANCE
$
Signature of Auditor
Date signed