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CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION Hcio
State Form 5473 (R2 / 592)
INSTRUCTIONS: See reverse side for filing instructions.
- - °''CERTIFI TION STATEMENT
I (We) _ _ _ cert ify that on the 1st day of March, 19
I (We upied as our rincipal place of residence the following described real property for which a Homestead Pro V111.61
l(We)owned ❑ Are buying under contract d�p®_1,J�-
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propOr a con r c .
NOV 10 1998
CONTRACTRECORDED,`.
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded R
Record num r a
age
PROPERTY DESCRI ON. - - - -' --
County Township Taxi dis _ct (a , to n to
r e number /}>Oc'� C1�� oral description
It any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to pr6duce 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. Signa!^ of claimant
tress (number and street, city, state, Z P code)
2
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON - RESIDENTIAL. ,
VALUE VALUE VALUE VALUE
Land not exceeding t (one) acre immediately ,
surrounding residential improvements. (1)
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (a) -
Residential improvements -
Garage (5)
Other improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 pIs line 7) (6)
I hereby certify the above is true, correct, and Signature of Assessor Date signed
complete.
verifying action - Signature of Auditor Date signed
- - STANDARD DEDUCTION ALLOWANCE'
19_Pay 19_
Lesser of 1/2 Homestead _
$
Valuation or $2,000
Signature of Auditor Date signed
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true, correct and complete. Signa!^ of claimant
tress (number and street, city, state, Z P code)
2
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON - RESIDENTIAL. ,
VALUE VALUE VALUE VALUE
Land not exceeding t (one) acre immediately ,
surrounding residential improvements. (1)
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (a) -
Residential improvements -
Garage (5)
Other improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 pIs line 7) (6)
I hereby certify the above is true, correct, and Signature of Assessor Date signed
complete.
verifying action - Signature of Auditor Date signed
- - STANDARD DEDUCTION ALLOWANCE'
19_Pay 19_
Lesser of 1/2 Homestead _
$
Valuation or $2,000
Signature of Auditor Date signed
- - STANDARD DEDUCTION ALLOWANCE'
19_Pay 19_
Lesser of 1/2 Homestead _
$
Valuation or $2,000
Signature of Auditor Date signed