Homestead_RuizCLAIM FOR HOMESTEAD PROPERTY TAX
;a CREDIT /STANDARD DEDUCTION
..,;' State Form 5473 (8215 -92)
rii7 -
INSTRUCTIONS: See reverse side for filing instructions.
e
FORM
certify that on the 1st day of March, 19
as & jrrin6ifoal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
(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 (city, town, township)
Parcel number
� -Od
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.
6-r
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
�reby certify the above statements are true, correct and complete.
Signature of claimant ,
Address (number and street, city, state, ZIP code) `'
�5 T
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 plis line i)
(g)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
tying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
. 19 _Pay 19_
.
Lesser of 112 Homestead
S
Valuation or $2,000
Signature of Auditor
Date signed
-I D -`?