Homestead_Grubb (5)e� x CLAIM FOR HOMESTEAD PROPERTY TAX FARM YEAR
3 " CREDIT /STANDARD DEDUCTION_ HCTo
State Form 5473 (R215 -92) -
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INSTRUCTIONS: See reverse side for filing instructions. � - R�
I CERTIFICATION STATEMENT —° 'a dL.A1L D I
I (We) t.a_J s. -.�O� _,ti "CS K , � X1.3 Ify that on thel7fAy9fi%IaTqg$9
I (We) occupied as our principal place of residence the fol6wing described real property for,which a Homestead Properf
y Tax Credit Js hereby claimed:
(We) owned ❑ Are buying under contract. AUD r
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ave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying act.
CONTRACT RECORDED
It buying on contract, Fee Simple owner's name
Recorder's office where contract is rew,cled Record number Page
` PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township)
Parcel number
0
Legal description -
It any portion of the residenu Ii ure or the land not exceeding one (1) arse 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 COUNTIES
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
cress (number and street, city, state, ZIP code)
ASSESSOR USE ONLY
TRUETAX
.VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL.
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
( (1)
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)
(7)
Total value (line 3 pfrs line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
IP
STANDARD DEDUCTION ALLOWANCE -
19_ Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
.
S
Signature of Auditor
Date signed _
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