Homestead_Smith (3)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R21 5 -92)
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INSTRUCTIONS See reverse side for filing instructions.
certify that on the 1 st
-1we) occu &d as our principal place of residence the following f— described real property for which a Homestead Property Tax Credit is hereby claimed:
1 (We) owned ❑ Are buying under contract W O "� U —q 9
El Have a beneficial interest in the entity that is liable for the property taxies 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 fs
County
County
Township
Taxing district t city r n. , wnsgp)
rc num el
el
I (9 o 0
legal description
If any porn f trye rig land not exceeding one (1) acre that immediately surrounds that structure is used to produce income. describe the use and portion
oft prop rt b to r„ uce .. -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
I Township
County
Township '
eby certify the above statements are true. correct and complete.
Signature of claimant -
Address (number and street. city. stale. ZIP code) % r/y 1
Lai
TRUETAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
ASSESSOR USE ONLY
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
S
surrounding residential improvements.
Of
Other land
I(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Olher improvements
I (6)
Total improvements (line 4 through line 6)
I (r )
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true. correct. and
I Signature of Assessor
I Date signed
complete.
ng action - Signature of Auditor
I Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
S
Valuation or S2.000
Signature of Auditor `
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