Homestead_DunnCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fonn 5473 W / 5-M
Premcfilmd by lhe Departrnard of Local Gooerrawd Frmhce
INSTRUCT70NS., See reverse ,We for filing instructions- FILED
I CATMSTATEKW.
- I . .*.* h ,_ . '771
0
I (We) on ta 44 of March. 20_
I (We)occupie�`aso& principal place of residence the Wowing described real property which a Hcrnesbead;p 'Tax-
'r Credit is hereby claimed:
I (We) owned ❑ Are buying under contract G _ a,
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns1Se0pUW§TyAQ;QJ&r a ountraL
CONTRACT. RECOROEO
NW"0'
ff btryring an ..b Fee Simple ommes name
Rmordef's office where cmtmd is remrded Record number Page
PROPERTY DESCMPTION' ,
County
Carry
Tmffr"n
town, townsho)
Parcel nurnber
LpWdescn
Ls
in
I
Land not exceeding 1 (one) acre inIffnediately,
Real prop" ❑ Motile H. (LC. &1.1 -7)
C any of the residential structure m the hind not exceeding one (1) amns dud imnusciately surrounds thal gliuclure
is used to prod" ihmrre, describe the rums and portion
ubkmd to Mod" v=vne.
C.ijo/- cco O� -Co /7
!':F4t&ERTYOWMECiBYCLAAMTINO*BtCOLikilES,.':- .'
County
Township
County
Tawrship
I hereby certify the above staternents are true. coned and cornplete.
of dWffwd
V uUmber and S&W4
We-A
I
Land not exceeding 1 (one) acre inIffnediately,
ONLY.
TRUE
L
Assi�VALUE
3HOVESTEAD-"
-'VALUE,.'f'
",t ""-'!',-N0N4WSl1DENTV
ASSESSOR USE
VJU.U'E-
OFTFV'-
T
Land not exceeding 1 (one) acre inIffnediately,
surrounding residential improvernents.
0
Other land
(2)
Rid land (Ire I plus Ire 2)
(3)
Dwelling
(4)
ResidenfialmVrovernentsor Annually
Garage
(5)
m
Assessed Mobile I Manulactured Horne
Other uVuvements
TctW unproverneffts (Aus 4 through fine 6)
(7)
Trial value (Ire 3 pkE lino 7)
(8)
1 hereby certify the above is true, coned, and
complete.
Signabure of Assessor
Date signed
Verifying action - Svmh" of P"cftw
Date signed
�::STANDARD DEDUCTION ALLOWANCE'
20_Pay20_
Lesser of 12 Hornestead
Valuation or s36'000
Signature of xktor
Date signed