Homestead_Likes. "" - CLAIM FOR HOMESTEAD PROPERTY TAX
`�' CREDIT /STANDARD DEDUCTION
I State Form 5473 (R215-92) .
_ ��
INSTRUCTIONS. See reverse side for riling instructions.
FORM YEAR
0
Cr TIFICATION STATEMENT
!`
I (We) \ cent n
UQFMN
I (We) occupied as our principal place of residence the following described real property for which a Homestead (elggpN get6UgM
❑ 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 burying under a contract. .
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
_ PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township)
Parcel number
Legal description
If any portion of the residential structure or the land not exceeding 7 acre that unmediately surrounds that structure is used to pr duce income, describe the use and portion of
the property utilized to produce income. -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
Signan a of claimant
ereby certify the above statements are true, correct and complete.
Addr7M ds" rry,s /Pco ) 1 ,�
Llf.
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1
surrounding residential improvements.
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assesor
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
' \
`-�V
Date sg ed
I �_