Homestead_Danns1 ° CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
:., State Form 5473(R2/5-92)
INSTRUCTIONS: See reverse side for tiling instructions.
M I
- CERTIFICATION STATEMENT' - • �yy— /
4-' certify that on the 1AI6AT4F�t(! 19
�) occupied as our principal place of nce'the wlq described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I (We) owned Are -bu in under contract -
❑ Have a beneficial interest in the e i that is liable he property taxes on the property and that owns the property or is buying under a contract.
_ CONTRACT RECORDED -
It buying on contract, F Simple owner's name
v '
Recorder's office where contract is recorded I I Record number Page
PROPERTY DESCRIPTION
Counly
-
Township
Taxing district (city, town, township)
Parcel umber
5 - 013K? '00
Legal description
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.
VALUE
VALUE
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
To n<h�p
I ;by certify the above statements are true, correct and complete.
lure claimant -
d ss (number and street, city, state, ZIP code)
/
VALUE
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
-
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(2)
Total land (line I plus line 2))
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pUs line 7)
(g)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
ng action - Sgnature of Auditor
Date signed
—1
I
19_Pay 19_
Lesser of 1/2 Homestead
Valuation or $2.000
STANDARD DEDUCTION ALLOWANCE
S
Date si