Homestead_Dilbeck (2)ea � a CLAIM FOR HOMESTEAD PROPERTY TAX
;��� CREDIT/STANDARD DEDUCTION -
.�.;,� StateFOrm5a73(R2/5-92)
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INSTRUCTIONS: See �eve�se side /or filing instmc(ions.
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I(We) certify that on the 7st day of March, 79_
1(We) occupied as ou principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
�I(We) owned ❑ Are buying under coniract
Have a beneficial interest in the entiry ihat is liable for the property taxes on the property and that owns the property or is buying,under a coniraci.
�� . CONTRACT RECORDED - - - �
II buying on contract, Fee Simple owner's name �. . . ' �
Recortler's ottice where contract is recortled Record number Page
Counry _
Parcel number
C�n�'--�:��
It any ponion of the residei
of the pmperry utilized ro p
/Y/� —
Township =:
PROPERTY DESCHIPTION
, - 7�inq tlistrict (city. fown, tawnship)
Legal description
� -6b -P-� �. .� � .`3 � -. o1-f 2� �f. 'J% A L
stmcmre or the lantl not exceeding one (7) acre that immediatety surmunds thai strucNre is used ro protluce income, describe the use and portion
ree income.
ASSESSOR USE ONLY . TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE� VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately
surrounding residential improvements. (�) �
Otherland (p)
Total land (line 7 plus line 2� (3)
Dwelling (4)
Residential improvements �
. Garage (5)
Other improvements (6)
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line 7) (g)
1 hereby ceRify the above is IrUe, correct, and Signamre ot Assessor Date sgnetl
complete.
Verifying action - SignaNre of Audimr Date signed
� STANDARD DEDUCTION ALLOWANCE
19 Pay 19 _
Lesser of 1/2 Homestead
Valuation or 52.000 S
Signature oi Autliror Da;e signed