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CLAIM�FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION . .
State fortn Sa73 (R2 / 5-92) �
INSTRUCTIONS: See �everse side 7ar /iling instructions.
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YEAR
�H� .��
DEC' 12 1997
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y-1h0f�0� B::�St'tl$�bl1T.l�f�h 19_
I(We) occupied as our principai place of residence ttie following descritied real property for which.a Homestead Property Tax Credit is hereby Gaimed:
�n I(We) owned ❑ Are buying under contraci
iave a beneficial interest in ihe entity ihat 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 con;ract, Fee Simple owner's name
Recorder's oHice where contract is recortletl Record number Page
� � � � "�" � PROPERTY DESCRIPTION � _ � - � �
Couniy ' � . Township � " ' � Taxing tlistrict (ciry, fawq township) '
Parcel number Legal descnption
- D S- -�VU -�.� , �.
It any portion of ihe residential strucNre or the Wnd not exceeding one (7) aae that immediatey surrounds that structure is used ro produce income, describe ihe use and portion
of the pmperty utilizetl m produce income. ,
� _ -�a iao ��ai�-- o��
• -
�PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �. ' -� -
Counry Township Counry Township
I hereby certify the above statements are true, correct and complete. Si n c e ot daimant
Q
�xss (number antl street, dry, sfate, ZIP co0e)
1 3�� 33o C�c.x �,l 4?bbs
ASSESSOR USE ONLY , . TiiUE TAX � ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE �VALUE VALUE VALUE �
Land not exceeding 1(one) acre immediately - .
surrounding residential improvemenis. (�) - � �
Otherland �2�
Total land (line 1 plus line Z� (3)
� Dwelling (4) �
Residential improvements _
Garage (5)
Oiher improvemenis (6) � �
Total improvements (line 4 through line � (7) I
� vaiue (line 3 p�s line 7� (g�
I hereby certify the above is true, correct, and Signamre ot Assessor � Dace signed
complete.
Verityirg action - Sgnamre ol Auditor Date signed