Loading...
Homestead_SampsonCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR i� CREDIT /STANDARD DEDUCTION HCIO �; • State Form 5473 (R2/5-92) rm INSTRUCTIONS: See reverse side for filing instructions. "CERTIFICATION STATEMENT - - pll��pp E 9 I (We) _ _ _ certify that on -the Q ABY of f01a 0,9 / 3 1 (We) occupied as our principal place of residence the.followin escribed real p perty for which a Homestead Property ax Credit is hhereb claimed: [] I (We) owned �1 ❑ Are buying under contract - UDITOR lave 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. I CONTRACT RECORDED - If buying on contract, Fee Simple owner's name .- - - Recorder's office where contract is recorded Record number Page ' PROPERTY DESCRIPTION County Township Township Taxing district (city, town, township) Parcel number © f to -'605W -DU Legal description bi 1p. It any portion of the residential structure or the land not exceeding one (1) acre that immediat surrounds that structure is used to produce income, describe the use and portion of the property utilized to produce income. (2) PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES - County Township County Township I hereby certify the above statements are true, correct and complete. Signature of claimant ess (number and street city. state, ZIP code) to 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 S2,000 Signature of Auditor Other land (2) Total land (line I plus line 2) (3) 0 Residential improvements Dwelling (4) - Garage (5) Other improvements (6) ' Total improvements (line 4 through line 6) (7) Total value (line 3 pfu line 7) (6) 1 hereby certify the above is true, Correct. and complete. Signature of Assessor Date signed Verifying action - Signature of Auditor Date signed STANDARD DEDUCTION ALLOWANCE ' 19 —Pay 19_ Lesser of 1/2 Homestead S Valuation or S2,000 Signature of Auditor Date 3 signed �3 �-