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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State ram 5473 (R7I SM
Prescribed by the Depertrreq of Local Gaierrcnerd Franca
INSTRUCTIONS: See reverse side for Minn insf rirlions.
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' •. CERTIFICATION STATEMENT, 3_ ! •d -.' r.:;
UlBbON COUNTY AUDITOR
I (We) certify that on the 1 at day of March, 20_
I (We) as principal of residence the fo5owinag described real property for which a Hoonestead Property Tax Credit is hereby daimed:
I (We) owned ❑ Pre buying under contract
Have a beneficial interest in the entity Mat is liable for the property taxes on the property and that owns the property or m drymg under a contract
CONTRACT RECORDED-',,`
If buyrg on mxba t Fee Simple owners reme
Fh owder§ of6rg where contract is momx1W Reid number Page
.:. `,�.. „ ?.. -'..r '. , .'.' •.+ PROPERTY DESCRIPTION..
Canty
Taxrrsfdp
T district ray town. townsrap)
Parcel axrber
Legal demmptiorr
Is the popery it question:
m of daumot
C .3 •S 3
11 Real ❑ Mobile Hann (I.C. 61.1 -7)
If cry portion of the residerdial Mmcbre m the land not exceeding one (1) acre bvt irnmedalely surrounds aired strumxe is used to prodme it w . descrbe the use and portion
property Wf®d to pmd ce tonne.
(y- 18- LJ03- 000.307 -007
;...
e'.'• .. :• .:' ` • PRwrERrY ownEo sr,CLADUURT m OTHER cOUPRES
`tin ., .` k
County
Tmnship
County
Txxvnship
I hereby xaNty the above statern eats are true, correct and complete.
m of daumot
4
s.. .,,VALUE. tx
(nwdw atreat city. stato. ZIP )
W7, 11
Land cwt exceeding 1 one sae irmtedi
Lai
` - ASSESSOR USE ONLY
TRUE TAX ..
ASSESSED VALUE
HOMESTEAD -
Y NON- (�5fDEtiT1AL'' ✓y�”
a 'fY > 't• s�;
•
VALUE'
,,AT10V%OFTTV
4
s.. .,,VALUE. tx
F
� .c'Vi'ViVALUE'�^c.. n?i «t;::
Land cwt exceeding 1 one sae irmtedi
starotmdirg residential improvernents.
mC R
OMer land
2
()
Total land (Iine 1 plus Ere 2)
(3)
Dvie
(4)
":rrf/?i�Yua:.`x`!)
Residential bfprOV @AIefIL$Or PJlfxlaltyDflg
-f
Assessed Mobile I AAarwfaxAaed Horne
Garage
(5)
Other bnprovernents
(6)
Total 'vnptovernents (foe I fhrouO lrie 6)
(7)
Thal value (line 3 pre dine 7)
(6)
1 hereby certify the above is true, correct, and
mnplete.
Sgnab" of wssmsar
Date sigrvd
Witfy'sg action - so.hae of M[fit"
Data signed
- . STANDARD DEDUCTION ALLOWANCE-
20 _ Pay 20 _
Lesser of 12 Homestead
Valuation or 536.000
5
Signaaxe of NrdM
Dale signed