Homestead_ThackerC,fi�fi>t
4E °, CLAIM FOR HOMESTEAD PROPERTY TAX
'= CREDIT /STANDARD DEDUCTION
State Form 5473 (R215 -92)
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INSTRUCTIONS: See reverse side for filing instructions.
STATEMENT
FORM „Y� R
HC10 (fJ
he) _Vi�hIWUU`-' certi hat on thye�ylCsyt addAOSf March, 19
) occupi sour pri cipal place of residence the following described real property for which a Homeste� V I 1 V R ereby claimed:
l(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
if buying on contract. Fee Simple owner's name y
Recorder's office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
PROPERTY DESCRIPTION
County
Township
1
Township
----------
Taxing dis ict (city, town, township)
I
Parcel number
16 - b1 oG1
Legal des ippon
13 f
11-511(t) g
If any portion of the residential structure or the land not exceeding Oie
of the property utilized to produce income.
(1) acre that immedately Lurrotinds that structure is used to produce income, describe the use and portion
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
----------
®eby certify the above statements are true, correct and complete.
Signatur claimant
Valuation or $2,000
Address (number and treet, citys te, lP cede)
Other land
It 9 3_l
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding t (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Signature of Aodi: (\�,
W
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 3pfrs line 7)
(13)
I hereby certify the above is true. Correct, and
complete.
Signature of Assessor
Date signed
&ng action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
5
Valuation or $2,000
Signature of Aodi: (\�,
W
Date signed
�4