HomeMy WebLinkAboutHomestead_McConnellc nx -
e.� g CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Foun 5473 (R2 15-92)
Hsu
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
- - • . - CERTIFICATION STATEMENT
\ � 1 ic certify that q,% the 1st davuof March, 19
I (We) o pied as our principal place of r idence the following desslcTibed Teal property for which a Homestead Prolowy/7A:iF,rA11 h coed:
❑ I (We) owned ❑ Are buying under contract AUDI 1 ��
❑ Have a beneficial interest in the entity that is liable for the properly taxes on the property and that owns the property or is buying under a contract.
r
CONTRACT RECORDED
It buying on contract, Fee Simple owner's name_ - -
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION -
Count� -
Township
Taxing distri t (dty, town, t i I
Parcel number
Legal de riphon
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
r -unty
Township
Count
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
Address (number and street, cat, state. ZIP code)
tp SII oS.
CqLe —J
ASSESSOR USE ONLY
TRUE TAX
.VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line I plus line 2)
3
l)
Residential improvements
Dwelling
(4)
,
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plrs line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
0 qing action - Signature of Auditor
Date signed
19_Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
ALLOWANCE