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CLAIM FOR HOMESTEAD PROPERTY TAX
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CREDIT /STANDARD DEDUCTION
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State Form 5473 (R215 -92)
Address (number and street, city, state, ZIP code) -
INSTRUCTIONS: See reverse side for filing instructions.
STATEMENT'
FORM YEAR
,•Ve) \/1 i,Ci1 C.(.r(� `f—_`� _ _� - certify that Property
•) occ ,ed as our principal place of resid ce the lowing for which a Homestead Property Tax C daimed
❑ I (We) owned ❑ Are bntract �"� _
❑ Have a beneficial in terest 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 owner's name - -
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County -
Township
Taxing district (city, town. township) ,
Parcel number
to
Legal description
Address (number and street, city, state, ZIP code) -
It any portion of the residential structure or the land not exceeding one (1) acte 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
County
Township FCoun;ly
Township
eby certify the above statements are true, correct and complete. claimant
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Address (number and street, city, state, ZIP code) -
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON-RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2.000
Signature of Auditor
Other land
(2)
_ _
Total land (line I 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 pUs line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
L 9+ying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 1l2 Homestead
S
Valuation or $2.000
Signature of Auditor
Date si ned
c.
_ _