Homestead_DeenCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R7150M
Prescribed by the DepertrreN d Loral Governnai France
INSTRUCTIONS: See reverse side for filing instructions.
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I (We) certify that on day�f� . 20_
1 (We) occupied as our principal place of residence the 'rg described real propedy which a Homestead Tax t is "��r dairred:
I(We)owned ❑ Are buying under contract S NCOUNTYAUDITOR
Have a beneficial interest in the entity that is liable for the property taxes on the properly and that owns the properly or is buying under a contrail
• . CON7RACTaRECORDmy ?7:7 �`"
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If buying on contract. Fee Singe owners name
Pmairder's olice where curbad b remdad Record number Page
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- PROPERTYDESCRIPT1ow-.
Township
County
Township
I hereby certify the above statements are true. correct and complete.
Teerg dsarcr (ray
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SIr(number
65 30 EttA:,( -<4-e ipwP s.; 7AI W& s'
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Legal description
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Prw" .b Fiprtie (LC. 61.1 -1)
if arty potion of the residential structure ar the lard m exceeding one (1) acre that inrtsRaady mmoun s dud s6ucture is used m pnxkm i cone, desabe the use and pertion
of the property utifrmd m produce mmne.
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PROrESm owNED sr cLamANr a OTHER coux7tES
County
Township
County
Township
I hereby certify the above statements are true. correct and complete.
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SIr(number
65 30 EttA:,( -<4-e ipwP s.; 7AI W& s'
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TR.UE.TAU( A
ASSESSED VALUE o
o HOAMSTEAD� ;
;;r �f MONi2FSIDEtlDALti'r Ty+
r'. ;ASSESSOR S
yA(_y)E:.AT, 1
1lt0%OF 77V�t,VALUE
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Land not exceeding 1 (one) am imredklb*
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(1) Y
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Other
(2) .
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Tdal land (lie 1 plus [no 2) (
(3)
astir;., c k f rfr
Dwelling (
(4) k
k Tv� 2:;.
Residential trrrprovennents or Annually D
Garage (
(5)
r ai
Assessed Mobile I Manufactured red home
Other unProvemenCS (
(s) .
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Trial "unproverrerds (inm e 4 through fine b) (
(T)
Trial value (lire 3 pis fine 7) (
(g)
1 hereby certify the above is true, correct, and S
Signature ofAssesso D
Dam signed
Venfytng action - signature of Arxbmr D
Date signed
,STANDARD DEDUCTION ALLOWANCE"
20 _ Pay 20
Lesser of 12 Homestead
Valuation or 535.000 5
Sig °at° —3 �-0