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Homestead_DaubenspeckdE �4 CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT /STANDARD DEDUCTION - P• State Form 5473 (R2/5-92) trio INSTRUCTIONS: See reverse side for filing instructions. occupied as our principal place of resid6ce the following described real property for which !� a �r a� Co ' 111 that on the 1 st day of March, 19 Property 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 owner's name Recorder's office where contract is recorded Record number Page PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES PROPERTY DESCRIPTION County Township Township Taxing district (city. town, township) Parcel number _ Legal description s-o -co Other land w - 3- Q If any portion of the residential swcture 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 p oduce m e b goo (3) PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES County Township County Township Weby certify the above statements are true, correct and complete. Signature of claimant ®tress (number and street, city, state, ZIP code) ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE Land not exceeding 1 (one) acre immediately surrounding residential improvements. 1 (1) 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 pits line 7) (6) I hereby certify the above is true, correct, and complete. Signature of Assessor Date signed rg action - Signature of Auditor Date signed Im STANDARD DEDUCTION ALLOWANCE I 19 _Pay 19_ Lesser of V2 Homestead Valuation or 52,000 S Auditor I Date signed