HomeMy WebLinkAboutHomestead_Kiesel (2)CLAIM FOR HOMESTEAD PROPERTY TAX - FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R2/5-92)
INSTRUCTIONS: See revers9e�v(ilin instructions.
` k ` ' "'- - - �r•. CERTIFICATION STATEMENT
certify that on th a?cWN619
WWI occupied as dur principal place of idence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
0 1 (We) owned [j Are buying under contract %� - _ _ ,��n��
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propertyt�orMis�b7uc"�•�®p><[rc.
- - ___. . ',CONTRACT RECORDED
It 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)
County
Township
iscertify the above statements are true, correct and complete.
f�c�b s i-ad t
Parcel number _
Legal description
ZIPcode) /J
iy I
01 3-ma-0 I
= 3 -/
II any portion of the residential structure or the land not exceeding
one (1) acre that immedi!y surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
,
u
ASSESSOR USE ONLY
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
HOMESTEAD
'VALUE
Township
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
County
Township
iscertify the above statements are true, correct and complete.
_
Si naturee of�claln and
Addres umber ands eet city. star
ZIPcode) /J
iy I
`
blest
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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 $2,000
_
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 pus line 7)
(6)
I hereby certify the above is true, correct. and
complete.
Signature of Assessor
Date signed
V ritying action - Signature of Auditor
Date signed
- STANDARD DEDUCTION ALLOWANCE - - -
19_ Pay 19_
Lesser of 1/2 Homestead
$
Valuation or $2,000
Signat of Auditor.
Date signed
Iaa('0 -,3
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