Homestead_Dixona� �� � CLAIM FOR HOMESTEAD PROPERTY TAX- ^ - FORM YEaR
_���'� CREDIT/STANDARD DEDUCTION ' HCio
.�,;'� S�ate Form 5473 (R2 / 5-92)
�su
INSTRUCTIONS: See reverse side lor Iiling instructions. � . . �
- � � � . -- �-CERTIFICATIONSTATEMENT' - � '" - � -
I (We) . � - �v' . . certify�thai on tF�f�ccF�% /�
I(We) occupied as our principal place o residence ihe fol wing described�real propeRy for which a Homestead Property-Taz Cred��imed:
�(We) owned ❑ Are buying under contract. .. . .
ILI Have a beneticial interesi in the entiry that is liable for the property taxes on the property and that owns the�property or is buying under a contract.
�� � • � -�CONTRACTHECORDED � � - � ��
tl buying on contrac; Fee Simple owner's name . , � �
Recorder's oflice where mn�ract is recorded Record number Page
County
PROPERTY-0ESCRIPTION. ' � . . � � � - �.
township)
rarceinumcer �e � ripnon y
- _ — o ¢��, � �- ia � : k�
li any portion of the resitlential sVUCture or the land not ezceeding one (1) acre that immetliatety surmunds that sWCmre is used to produce income, describe the use and portion
of ihe prppe utilized to produce inwme. - ,
��5 a3�51�0 -
�„av�„r,o�,�.����
- � PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES - � � - � ��� � � �
Caunry � Township Counry � To ff� �
��+ereby certify ihe above statemenis are true. correct and complete. Signamr ot aaimant ,
� ress (num6er and sbeeL ury, stare, ZIP aMe)
� �
� ASSESSOR USE ONLY ,� TRUE TAX . . ASSESSED HOMESTEAD NON-RESIDENTIAL
. � VALUE= ' VALUE �VALUE VALUE -.
Land noi exceeding 1(one) acre immediately �
surrounding residential improvements. (�) . � � . �
Otherland (p)
Total land (line 7 p/us line � (3) �
Dwelling (4) " � �
Residential improvemenis . �
Garage (5) � � �
Other improvements (6) . �� � .
To�al improvements (line 4 through lina � (7)
Total value (line 3 p�s line � (g)
I hereby certify the above is irue, Correct, and � Signature of Assessor ' Date signed �
complete.
Veritying aaion - Signature of Audimr Date signed
- - � - STANDARDDEDUCTIONAILOWANCE - _ -
79_Pay19_
Lesser of 1/2 Homestead
Valuation or 52.000 S
SignaWre ot Audiror �' Dare signetl _ �