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Homestead_Campbell (2)CLAIM FOR HOMESTEAD.PROPERTY TAX.
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5.92)
Abu
INSTRUCTIONS: See reverse side for tiling instructions.
1 �• s
r
'e) T l 1`l Q\ V lxl certify that on the 1 st day of March, 19
occupied as our principal place of residence the following described real property for hich a Home ead Properly Tax Credit 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 - -
If buying on contract, Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
PROPERTY DESCRIPTION
Co y
Township
Township
Taxing tlietriCt try town, to Ship)• _
<<
A ess( number and sweet, city, state. 2lPcode)
Parcel number.
Leg
de
Jon
Total land (line t plus line 2)
(3)
It any portion of the 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.
r
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
®eby certify the above statements are true, correct and complete.
S' n , of claimant
A ess( number and sweet, city, state. 2lPcode)
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 t 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 pLs line 7)
(6)
1 hereby certify the above is true, Correct, and
complete.
Signature of Assessor
Date signed
%, - ng action - Signature of Auditor
Date signed
19 —Pay 19_
Lesser of 1/2 Homestead
Valuation or $2,000
STANDARD DEDUCTION
S
Signature of Auditor I Cate signed