Homestead_Rudolphsa a CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION"
State Form 5473 (13215 -92)
rsu
INSTRUCTIONS: See reverse side for filing instructions.
R.
DEC 0b 1996
certify. that on the 1st day a►M3efhTQR
occupied as our principa placeJof residence the following described rea4operty for which a Homestead Property Tax Credit is hereby claimed:
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
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 (pry. town" township)
Parcel number
-6
Legal description
It 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 -
County
Township
County
Township
®eby certify the above statements are true, correct and complete-
Signature of claiman
.
Address (number and street. pry. state. ZIP code)
Ili - 6I% D A a A/ Y2e 46 y
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE.
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
-
Signature of AuditorDate
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 plrs line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
va ing action - Signature of Auditor
Date signed
- STANDARD DEDUCTION ALLOWANCE
19 —Pay 19_
-
Lesser of 112 Homestead
S
Valuation or $2,000
Signature of AuditorDate
signed
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