Homestead_SpurgeonL
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
3� CREDIT /STANDARD DEDUCTION HCtO
State Form 5473 (R2/5-92)
%ae
INSTRUCTIONS: See reverse side for filing instructions.
0 F, 6M. l7
1.
*(We �A�� ✓SIG• I 0 0 lL_X„yC jc-- certify. Ih 1st f ar , 19
cu i d as our principal place of residence the i lowing descr d real property for which a Homestead e T� Oil Fu h Gaimed:
We) owned ❑ Are buying under contract tL,��ppRR �nnQ
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propbRy'br 1 buyingJ under a contract.
CONTRACT RECORDED / t��- ✓ %J7:-in i
If iwying on contract. Fee Simple owners name - - `
._ _.
Recorders office where contract is recorded
number
' PROPERTY DESCRIPTIO
County
Township ..
Taxing distr' ,own, /ow
Legal description
�eby certify the above statements are true. correct and complete.
Sign atur of d
nt
Address (number and street, city. state, ZIP code)
t.
If 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
wnshi
Lesser of 1/2 Homestead
�eby certify the above statements are true. correct and complete.
Sign atur of d
nt
Address (number and street, city. state, ZIP code)
t.
Date signed
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding I (one) acre immediately
surrounding residential improvements.
(1)
-'
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 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
is
Date signed
' STANDARD DEDUCTION ALLOWANCE'
19 _Pay 19
Lesser of 1/2 Homestead
$
Valuation or $2,000
Signature of Auditor
Date signed