HomeMy WebLinkAboutHomestead_Butlertyf ?`f r1
ei CLAIM FOR HOMESTEAD PROPERTY TAX FORM
raj CREDIT /STANDARD DEDUCTION HCio
`' • State Form 5473 (R215 -92)
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INSTRUCTIONS: See reverse side for filing instructions.
1 .. � T n� CERTIFICATION STATEMENT -. Fi- If n. s y I A U -H I
I (We) CU1tJ 1�—' \ 1 \� �. certify. that on the 1st da %Aa�1111
e) pied as our principal place ofI place of resideneSe following described real property for which a Homestead Property Tax�redii is hereby daim
!LWI -(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
CONTRACT RECORDED '
It trying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIP
ON
County
Township
Taxing
�c�IQ7mber /� ^ I
Legal description
It any portion of thee` 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
County Township
IF�eby certify the above statements are true, correct and complete.
Signatuw of claimant e
l /J.�1 tYnX/I1�'nar
Address (number and street, city, state, Z code
'/ /S >.a� 2�
7666
ASSESSOR USE ONLY
TRUE TAX
.VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE -
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Signature of Auditor
DayCSyned� .._
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 pfis line 7)
(6)
I 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
Valuation or $2,000
S
Signature of Auditor
DayCSyned� .._