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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5 -92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
s
.x aa� 11.E
MAY ]995
CERTIFICATION STATEMENT /I r
I (We) - certify that orAQj D VRI Wick 19
) occupied as our principal place of residence thO following described real property for which a Homestead Property Tax Credit is hereby claimed:
1
(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 DESCRIPTION
County
Township
Taxing district (city, town, township)
P ^el number
Legal description
Sig lure of claimant
n -62a 10 0
Date si ned
If any porton of the residential structure or the land not exceeding one (1) acre that " iately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
(2)
ono -oaaI M
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
certify the above statements are true, correct and complete.
Sig lure of claimant
�reby
Address (number and street cil)4 state, ZIP code)
R ti
/t
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
Date si ned
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(S)
"
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pf/s line 7)
(g)
1 hereby certify the above is We, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 1/2 Homestead
Valuation or 52,000
$
Signature of Auditor
Date si ned
— T