HomeMy WebLinkAboutHomestead_Sandleben (2)STATEMENT
FORM YEAR
HC70 9
certify that on d 0 I 19 /
r tvJe) occupied as our princPol,pla�ce of rresi`dence the following described real property for which a Homestead Propert-1y az r It is hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract - - �,/. _ _ t
❑ Have a be interest in the entity that is liable for the property taxes on the property and that owns the property or is Al DJfiGifYbQcintract.
_ - CONTRACT RECORDED
If buying on contract, Fee Simple owner's name - -
Recorder's office where contract is recorded Record number Page
- PROPERTY DESCRIPTION
CLAIM FOR HOMESTEAD PROPERTY TAX
y
CREDIT /STANDARD DEDUCTION
';.
State Form 5473 (13215 -92)
It any portion of ine residential structure or the land not exceeding one (1) arse that immediately surrounds that structure is used to produce income, describe the use and portion
of the properly utilized to produce income.
r
INSTRUCTIONS: See reverse side for Nina instructions.
STATEMENT
FORM YEAR
HC70 9
certify that on d 0 I 19 /
r tvJe) occupied as our princPol,pla�ce of rresi`dence the following described real property for which a Homestead Propert-1y az r It is hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract - - �,/. _ _ t
❑ Have a be interest in the entity that is liable for the property taxes on the property and that owns the property or is Al DJfiGifYbQcintract.
_ - CONTRACT RECORDED
If buying on contract, Fee Simple owner's name - -
Recorder's office where contract is recorded Record number Page
- PROPERTY DESCRIPTION
County -
Township
Taxing district (city, town. township)
Parcel number
Legal description
It any portion of ine residential structure or the land not exceeding one (1) arse that immediately surrounds that structure is used to produce income, describe the use and portion
of the properly utilized to produce income.
r
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
TRUE TAX
VALUE
County
Township
County
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Township -
0 eby certify the above statements are true. correct and complete.
Signa' f daimar I
Address (number and street, city, state, ZIP code)
J� 4/,7&-3,q
1.
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line i plus line 2)
3
l)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plrs line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
ing action - Signature of Auditor
Date signed
19_Pay 19_
Lesser of 1I2 Homestead
Valuation or $2.000
STANDARD DEDUCTION
S
Sgnawre of Arw'i;or— �I — Date Ls��pned /�_