Homestead_Killional . CLAIM FOR HOMESTEAD PROPERTY TAX Po YEAR
s'
CREDIT /STANDARD DEDUCTION HG
..j1 State Form 5473 (R2 / 5 -92)
ass
INSTRUCTIONS: See reverse side for tiling instructions. 'NOV 2 9 1994
• CERTIFICATION STATEMENT
(`1�� _ 1p� /a
IS
`e) �1Y�Aa certify that on the 1 st daAU ENTC10
1 1 W'e) occupied as our principal place of residence the foll6wing d cribed real property for which a Homestead Property Tax Credit is hereby claimed:
l(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 - -
Count
Towns ip
Taxing district Iciry, town, township)
Parcel number
Legal description
C�,Oio ts
Address (number and street, city. state. ZIP code)
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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
®reby
Township
County
Township
certify the above statements are true, correct and complete.
Signature of claimant -
Address (number and street, city. state. ZIP code)
ASSESSOR USE ONLY -
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000 -
L_
= Sigmmre of Auditor ^.�
Otherland
(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 pUs line 7)
(g)
1 hereby certify the above is true, correct, and
.
Signature of Assessor
Date signed
oplete
tying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
S
Valuation or $2,000 -
L_
= Sigmmre of Auditor ^.�
Date signed — --