Homestead_DevischeybergenaE`��^�� CLAIM FOR NOMESTEAD PROPERTY TAX -
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�. CREDIT/STANDARD DEDUCTION
a, :
�,` � State Form 5a73 (R2 / 5-92) � �
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INSTRUCTIONS: See reverse side to� /iling instructions.
�� ' CERTIFICATION STATEMENT
FORM J YEAH
►+R�lY 199
�wn� ,�i'. d'h,�y-s
e11nIT(1R
principal place ol residence the foilovring descri d real p perty for which a Homesiead Property Tau Credit is hereby Gaimed:
�(We) owned ❑ Are buying under wntraci � �
❑ Have a beneficial interesi in the eniity thai is liable for the propeny taxes on ihe property and that owns ihe property or is buying under a contract.
' CONTRACTRECORDED �� • � �
Itl buying on contrad, Fee Simple owner's name �
Recorder's oftice where contract is rewrded ' Record number Page
PROPEFiTY DESCRIPTION
7� Tacing tlistrict (ciry, ro, township)
7//
t--�� - vvie+ a i�/rr�c c�i�.tir c cAZ.��i c� /�r �
If any portion of the residential strucmre or �he lantl not exceeding one (7) aae that immediatey surrounds that struMUre is usetl to produce income, descnbe Ihe use arW
ot the pmperty utilized to produce income.
ASSESSOR USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residential improvemenis.
Otherland
Total land (line 7 plus line 2�
Dwelling
Residential improvemenis
Garage
Oiher improvements
Total improvements (line 4 through line �
Total value (line 3 p�s line 7�
I hereby certify the above is true, correci, and
camplete.
.yirg �ion - Signa;ure of u ito; �
19_Pay19_
Lesser of ll2 Homestead
Valuation or 52.000
`
TRUETAX ASSESSED
.VALUE VALUE
(�)
(21
(3)
(4)
(5)
(6)
(�)
(8)
Signature of Assessor
STANDARD�DEDUCTION ALLOWANCE
S
HOMESTEAD I NON-RESIDENTIAL
VALUE VALUE
Date signed
Date sipned
signetl