Homestead_Egdorf4
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
'� u • J State Form 5473 (R5 / 10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for (ling instructions.
LFORM YEAR
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=- ;%�Si C . to : '°fir :�GERTIFICA Y _TION STAIEMENTT, . /.. H / ,
E/ � w.
(We) Y` O R F L : �fTN C Lenify that on the 1st day of March, 20_
(We) occupied as our principal place of r4sidence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract
lave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buyingvrder a,contracl.
I, r It i! lip , ,l
If buying on contact, Fee Simple ownees name
Recorder's office where contract is recorded
Record
_��"'_ #�� a? "`.,- yam_%` -'� ��; �`?ti''.�-ex�"_'-2s�'a'�y�.:
PROP .ERT.Y.DESCRIP,TIONa"�:= ,"�p.- Y'`'et t�Y"�? -?4' '. .. a�=•�
County r
Tavnshi
N', NON- RESfDENTIAL - -'
Taring disY \ ity, t township)
VALUE.z z-.
_AT 100°/ OFNTTV�,x
y/�, q
�'VALUErr, Vic"
Parcel mbar
Legal description
Is the property in question:
�/
Q 7— o o
surrounding residential improvements.
❑ Real property ❑ bile Homo ( /.C. 6- 1.1 -7)
If 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.
County
Township
I hereby certify the above statements are true, correct and complete.
and street ciWtale, ZIP code)
County
OR!- ASSES OS RUSE ONLY'^3
All. TRUE TAX =
t.'
ASSESSED VALUE
HOMESTEAD -
N', NON- RESfDENTIAL - -'
, �''`
" x�.. xyz+}¢.._- ,?+.'�'` -tv'wY
VALUE.z z-.
_AT 100°/ OFNTTV�,x
VALUE -.
�'VALUErr, Vic"
Land not exceeding 1 (one) acre immediately
tv r3,Fr -»
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
J
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of assessor
Date signed
complete.
Veil ying action - Signature of Auditor
Date signed
r
L
z;STANDARD�DEDUCTIONALLOWANCE _,o�'A4 z >- -
20 _ Pay 20
Lesser of 1/2 Homestead
$
Valuation or $6,000
Signature of Auditor
Date signed