Homestead_BallCLAIM FOR HOMESTEAD PROPERTY'TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5 -92)
ieTs
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC,O 3
I (We) // /i'j/wYili"" y / /(�Ui/7Ltl� „�( x /`� certify that on the 1st day of March, 19
,,�Ye) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
WI(We)owned ❑ Are buying under contract
L7 Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propeRy�is.Quy�ng under�a
Til
CONTRACT RECORDED
If buying on contract, Fee Simple owner's name
�J Page
PROPERTY DESCRIPTION
County
Township -
Taxing district (city, to
NON -RESIDENTIAL
VALUE
Par 1 n� ber
C S t�05 6 -n
Legal description
�1 -3-/,2(J �7y
If any portion of the residential structure or the land not exceeding one (t) 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
I' reby certify the above statements are true, correct and complete. Signature
l Press (number and street. city state. ZIP Code)
121_ 3 804 311 'y IL SF 7665
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 52,000
Signature of Auditor
Otherland
(2)
Total land (line 1 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 plus 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 1/2 Homestead
S
Valuation or 52,000
Signature of Auditor