Homestead_LakeCLAIM FOR HOMESTEAD PROPERTY TAX �, FORM YEAR
CREDIT/STANDARD DEDUCTION
% State Form 5473 (R614 -03)
Prescribed by Na Department of Local Government Finance
INSTRUCTIONS: S" verse side for riling instructions.
�RTIFI OALTION STATIEMIENTe4�- `- 77�1;-:��-!��
I (We) certify that -p-IV�WW,(�;March, 20_
I (We) occupied as our principal place of residence the following described real property for which a Homestead ,PB rSo�,rty ;N[fWaimed:
G
I (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-, RIECORDED�4
If buying on contram Fee Simple owner's name
Recorders office where contract is recorded Record number Page
PROPERT.Y,-bESCRIPTfOk�v
County
Township
Todng district (city to
1 1
Township
OMM53 -co
Legal description
Is the property in question:
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Land not exceeding 1 (one) acre immediately
Real property ❑ Mobile Home (I. 6 .7)
If any portion of the residential structure or the land not exceeding one (1) am that immediately stimounds the t sdhtre
is used to produce income, describe Na use and portion
of the property utilized to produce income.
surrounding residential improvements.
D�
PROPERTYAO E B
County
Township
C . ounty
Township
I hereby certify the above statements are true, correct and complete.
If
bn
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caimU ant
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Tess (number z gI
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ASSESSOR
ASSESSOR -USE
TRUEWI�,
ASSESSEDVALUE
'NORESIDENTIAVI,—
W
,
"T 9R DFT1r1-
.
VAL U E,
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Land not exceeding 1 (one) acre immediately
Signaure
Date signed
0540 --O's
surrounding residential improvements.
Otherland
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
improvements
(6)
.qtIst
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
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-,�
20 _ Pay 20
Lesser of 1/2 Homestead
Valuation or $35,000
Signaure
Date signed
0540 --O's
I-" I - 1!7