Homestead_GreenCLAIM FOR HOMESTEAD PROPERTY TAX
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CREDIT /STANDARD DEDUCTION
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State Form 5473 (132/5-92)
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INSTRUCTIONS: See reverse side for filing instructions.
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MJK 1 y Pat
-. - - CERTIFICATION TATEMENT -
1) - f .. certi fy. a t
occupied as our principal place of residence the following describe r at property for which a Homestea o(xeng(F6k lhere6y di n d:
❑ 1 (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
It buying 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 npmh-r rn ^ w �
Legal description
It any po`rtiion of the residential structure oor`r the land not exceeding one (t) acre that im iately 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 COUNTIES
County
Township
County
Township
*by certify the above statements are true, correct and complete.
Signature of claimant
Address (number and street, city, state, ZIP code)
I)Aa W.
iI U
ASSESSOR USE ONLY -
TRUETAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Signature of Auditor Date signed
Other land
(2)
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
I (7)
Total value (line 3 plus line 7)
(S)
1 hereby certify the above is true, correct, and
complete. -
Signature of Assessor
Date signed
V =�fving action - Signature of Auditor
Date signed
- STANDARD DEDUCTION ALLOWANCE
19 —Pay 19_
Lesser of 1/2 Homestead
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Valuation or $2,000
Signature of Auditor Date signed
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