HomeMy WebLinkAboutHomestead_Lewis (2)CLAIM FOR HOMESTEAD PROPERTY TAX
° CREDIT /STANDARD DEDUCTION
State Form 5473 (R215-92)
INSTRUCTIONS: See reverse side for filing instructions.
C E RTIFICATIO"TATEMENT
YEAR
r
rd
I (We) certify t ton the !'%o arch,
I (We) occupied as our principal place of residence the following descri a real property for which a Homestead Pr e�c ,; `. bye d:
❑ 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 RECORDED.
It buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
TownstJp
Taxing district (city, town, township)
Parcel number
l
Legal description
If any portion of the residential structure or the farad net exceeding
the property utilized to produce income.
oft J1 ) acre that immediatety gurrounds that structure is us&d to produce income, describe the use and potion of
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
.ereby certify the above statements are true, correct
and complete.
Si natur o aimant
rY/
A ess (number and street, city, state, ZIP code)
/
/ ]
7 U
ASSESSOR USE ONLY
V/fiiiUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON-RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(2)
-
Total land (line 1 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 plus line 7)
(8)
I hereby certify the above is true, correct, and
complete.
Signature of Assesor
Date signed
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
Valuation or $2.000
S
Signature of Auditor
Date signed