Homestead_MemmerCLAIM FOR HOMESTEAD PROPERTY TAX -
CREDIT /STANDARD DEDUCTION
/• State Form 5473 (R2 / 692)
16
INSTRUCTIONS: See reverse side for filing instructions.
F YEAR
ORM
HC7�-
JAN 2 0 20on
CERTIFICATION STATEMENT
I f r f er(ljy on theft st'0y.W
(We) -k
I e occupied ur rinci al lace of residence the following describe eat for which a Homestead Pro e Tax Cl��t F3{fiPJr cl Imed:
(W) P principal P 9 property P rty � 1:1, y eK
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
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township
Taxing district( ty; town, townshi )
Parcel number -
Legal description
eal 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
If any poNOn of the residnti
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
Signat of claimant
,ereby certify the above statements are true, correct and complete.
Addres number ands wt, cipKs a e. ZIP e)
ASSESSO USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
- SI ENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Other land
(2)
Total land (line I 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)
I 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
Date signed