Homestead_Barrett (6)CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
� t :• .FORM
CREDIT /STANDARD DEDUCTION y HC10
State Form 5473 (R2 / 5-92) A
INSTRUCTIONS. See reverse side for filing instructions. 1 2 2 2001 a«=
'
ULKI IMCA I ION 5TAI EMENT
I (We) "f e4 . ..r' , .fylthhat / day of March, 19_
I (We) ecpedT, our principal place of residence the following described real property for which a Homest ed Proper}) Pit is hereby claimed:
❑ I (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
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
couiv
Township
T d trict (city, town, township)
Parcel number —1
CID 5 -0 is 1� -OO
Leg�ewdption I
' _
It any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is u d to produce income, describe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
=.reby certify the above statements are true, correct and complete.
Si lure of claimant
Address (number and street, city. state, ZIP code)
R R +l ) BvK 3 3 WA 0r &�
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(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 plus line 7)
(8)
I hereby certify the above is true, correct, and
complete.
Signature of Assesor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
Valuation or $2,000
$
Sig l of Autlilor
Date signed