HomeMy WebLinkAboutHomestead_AmbroseCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
';. State Form 5473 (R215 -92)
reu
I (We)
INSTRUCTIONS: See reverse side for lilino instructions
occupied as our principal place of residence the
FORM }� �j YE��AR
H J II II I �+
g �J�
k-/C= Lw` certify that on the I
real property for which a Homestead Property Tax
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
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTIO
Gounty
Townsh
Taxing dis rict city, town, to nshi )
Parcel number
CtJ 5
Legal descri n 11�JC/
g411 ^ „ ^
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I
If any portion of the residential structure or the land not exceeding one (1) acre thatUmediately 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
County
Township
� -reby certify the above statements are true, correct and complete.
Signat . t mans
.5cre m r street, city ate, Pcode
ASSESSOR USE ONLY
TRUE TAX
,VALUE
ASSESSED
VALUE.
HOMESTEAD
VALUE
NON - RESIDENTIAL.
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
S
Other land
(2)
..
Signature of Auditor
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 pUs line 7)
(g)
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 112 Homestead
S
Valuation or $2,000
Signature of Auditor
Date sicaad--_�