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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
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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