Homestead_BurkeeE „ CLAIM FOR HOMESTEAD PROPERTY TAX
i CREDIT /STANDARD DEDUCTION
State Form 5473 (R215 -92)
aiY
INSTRUCTIONS: See reverse side for filing instructions.
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FORM Y R
HC70
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PROPERTY DESCRIPTION
• CER
FIC Ido STATEME ^ - -
I 'We) certify that on the t st day of March, 19
ied as our principal pla of residence th following described real property for which a Homestead Property Tax Credit is hereby claimed:
;-1 I ( ow a ned ❑ 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 buyin ntract.
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
oy certify the above statements are true, correct and complete.
_ _ 3 _ /
CONTRACT RECORDED
It buying on contract. Fee Simple owner's name 'APR 10 1995
Recorder's office where contract is recorded
Wrd number y1, Page
All
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
PROPERTY DESCRIPTION
County Township - -
Taxing district (city, lawn. township)
a er- 0 3o 5_ Q -6Legal description
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
oy certify the above statements are true, correct and complete.
_ _ 3 _ /
Address (number an reef, crty, state, ZIP do) /
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Otherland
i/ '
It any portion of the residential structure or the land not exceeding one (1) eae that immediate y surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
Total land (line 1 plus line 2)
(3)
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County
-county
HOMESTEAD
VALUE
- NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
oy certify the above statements are true, correct and complete.
nature of claimant
Address (number an reef, crty, state, ZIP do) /
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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 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 plrs line 7)
(g)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
�ng action - Signature of Auditor
1
Date signed
I - STANDARD DEDUCTION ALLOWANCE - I
19_Pay 19_
Lesser of 112 Homestead
Valuation or $2,000