HomeMy WebLinkAboutHomestead_DehartCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HCTo
State Form 5473 (R2/5-92)
ate
INSTRUCTIONS: See reverse side for filing instructions.
I (We) —1 —`UA ( 'I- 0L1- OA -4 certify that on thcQalf c2M %/ 19
�e) occupied as our princip ^'lace of residence the following described real property for which a Homestead Pr"TIax is hereby clamed:
LJ 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 er
OR
CONTRACT RECORDED
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
- PROPERTY DESCRIPTIO
County -
Township
Toxin ric (- .tow town hip)
Parcelobpr S '
Legal dese7, W C-)6 _� - 3.) MC
II 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.
Cat —
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
eby certify the above statements are true, correct and complete.
Signature of claimant
Address (number and street city. slate. ZIP code)
Qo 3oP osv, /c
7GG
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
azure of Aud or
Date yd
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 pUs line 7)
(g)
I hereby certify the above is true, correct. and
complete.
Signature of Assessor
Date signed
®fving action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19_
Lesser of 1/2 Homestead
V luation or $2,000
S
azure of Aud or
Date yd