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_•�CLAIM FOR HOMESTEAD PROPERTY TAX
'= CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5 -92)
aie
INSTRUCTIONS: See reverse side for filing instructions.
FORM AR.'
HC70
' CERTIFI ON STATEMENT - -
1 (We certify. that on the 1st day of March, 19
c pied as our principal place residence the following described real property for which a Homestead Property Tax Credit is hereby
. claimed,
I (We) owned ❑ Are buying under contract - k'i�. " ,�
❑
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the arty oRr IS buuir�f "d"d�e•_a call ntract.
If 9U4k
CONTRACT RECORDED ; „� _ _ .lt;)n `• - " _
If buying on contract, Fee Simple owner's name I -
Recorder's office where contract is recorded Record n Page
` - PROPERTY DESCRIPTIO
- - "
County
Township
Taxing distr t (ci , to r , town ip) ,
c u
(1)
gal descriptio _
It any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is u4S5,6 produce income, describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surroundingresidentialimprovements.
(1)
reby certify the above statements are true, correct and complete. •
I
Sin Lure of claimant
A dress (number and street, ci ,state. ZIP code)
ASSESSOR USE ONLY
TRUE TAX
VALUE.
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surroundingresidentialimprovements.
(1)
Valuation or $2,000
-
- -
Other land
(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 pfrs line 7)
(8)
I 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
$
Valuation or $2,000
Signature of Auditor
Date signed