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CLAIM FOR HOMESTEAD PROPERTY TAX
Township
CREDIT /STANDARD DEDUCTION
iota
State Form 5473 (R215 -92)
INSTRUCTIONS: See reverse side for filing instructions.
4 FORM Y
�0 ``
- . d EAR
El
certify that ohlhL�V&ly -i`8
occupied as ou , ncipal place of residence the following described real property for which a Homestead Property T rG rtli ley
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 properly or is buying under a contract.
CONTRACT RECORDED
It buying on contract, Fee Simple owners name -
Recorder's office where Contract is recorded Record number Page
-- PROPERTY DESCRIPTION -
County
Township
Taxing district (city, town, township)
Parcel number
V oa
Legal description
It any portion of the residential structure or the land not exceeding one o) ) 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
County
Township
HOMESTEAD
VALUE
County
Township
I hereby certify the above statements are true, correct and complete.
Valuation or S2,000
Signatur f Caiman
Address (number and street, city. state, ZIP code)
c, 41 s w . Col", C' S+
bi, Tnd �,Pb 6o
ASSESSOR USE ONLY
TRUETAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
- NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(11
Valuation or S2,000
Si ture of Autlitor
Other land
(2)
Total land (line 1 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)
I hereby certify the above is true, correct, and
aplete.
Signature of Assessor
Date signed
Wing action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE - -
19 _Pay 19_
Lesser of 1/2 Homestead
S
Valuation or S2,000
Si ture of Autlitor
Date signed II