Homestead_Davis (7)CLAIM FOR HOMESTEAD PROPERTY TAX ; @FORM TN-
YEAR
CREDIT /STANDARD DEDUCTION �HC10
; State Form 5473 (R215 -92) -'
INSTRUCTIONS: See reverse side for filing instructions. MY 10 1994
I CERTIFICATION STATEMENT �cx.z 4t4 b",,
AUDI certify that on the 1st a�of March, 19
11v4,) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimek
❑ 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 DESCRIPTION
County
Township
Taxing district (city, town, township) _
Par el number
®S- C93�bV-Vo
Legal description
=P
3y'3 -ia .So 71-
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used o produce income, describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
TRUE TAX
VALUE
County Township
County
Township
by certify the above statements are true, correct and complete.
Sign ur f claimant ``
I
nn •• ^^^�.,
lMl rJ
Address (number and street city, state, ZIP Woe)
( 60K
1V
/ ' tj I
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)
17)
Total value (line 3 pfis line 7)
(6)
1 hereby certify the above is true, correct, and
r,olete.
Signature of Assessor
Date signed
. g action - Signature of Auditor
Date signed
19 _Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
Signature
ALLOWANCE
S
,� Date si nec