HomeMy WebLinkAboutHomestead_Curl°ems -o s CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC1D
.,' State Form 5473 (R215-92)
INSTRUCTIONS: See reverse side for filing instructions.
I fwe) Ly_.�.�.c� Z' SiSL.Gy.] certif�, at on the 1 st day of March, 19
Woccupied as our princip I place of residence the following described real property for which a Homestea( �m5 q- TaD,TOedrashelebyy claimed:
(We) owned ❑ Are buying under contract Au
❑ 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 owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township
PROPERTY DESCRIPTION
County
Township
Address (number and street. city, state. ZIP code)
(R-A- l lB,,c ('77C C)Lc/eA5�lf( TA) L�7(,
Taxmg district (city. town, township) ,
Parcel number
005 -a636C,5 -a
Legal description
G-
a - 0•.3 -o"2-1
-V2
If 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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township
County Township
sb y certify the above statements are true, correct and complete.
Signature of claim t
ac
J► //� //„ �/,
Address (number and street. city, state. ZIP code)
(R-A- l lB,,c ('77C C)Lc/eA5�lf( TA) L�7(,
ASSESSOR USE ONLY
-
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON-RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(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
�fying action - Signature of Auditor
Date signed
DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 112 Homestead
S
Valuation or $2,000
Signature