HomeMy WebLinkAboutHomestead_Doss\' '—
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a� "; CLAIM FOR HOMESTEAD PROPERTY TAX
i��'� CREDIT/STANDARD DEDUCTION
� Stare Form Sa73 (R2 / 5-92)
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INSTRUCTIONS: See reveise side lor liling instructions.
FORM YEAR
H ,r1 �r �r-�,5
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' CERTIFlCATIONSTATEMENT � ` � "-""' `°°°
I (We) certify�thai on(y�ytsf�day o(j�larcr�,(,F,9�`�.l�
�^ve) occup as our principal place of residence the following described real property tor which a Homestead Property Tax Cr�����lainmed:
1(We) owned ❑ Are buying under contract .�
Have a beneficial interes� in Ihe eniiry ihai is liable for Ihe property taxes on ihe property and that owns Ihe property or is buying under a wntraci.
. CONTRACTRECORDED ' � -
If buying on contraa. Fee Simple owner's name
ReCOrder'S oflite where Contraci i5 retorded Retord number Page
County
Parcel number
Leqal
PROPEflTY DESCRIPTION
town,
- ,e.a� �� vw —.�—i T
It any ponion oi ihe resitlential stmcture or the land not exceeding on �) acre that immediarety surrounds that strucmre is used m protluce iraome, describe Ne use and portion
of the property utilized to produce income.
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
County Township -_ County iownship
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� cehify ihe above statements are true, correct and complete. siqn re of
(numberandsveeLCiry.state.ZlPCOOe) .
T
ASSESSOR USE ONLY . TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL -
. .VALUE VAWE VALUE VALUE -
Land not exceeding t(one) acre immediately
surrounding residential improvements. (� � . -'
Other fand (2)
Total land (line 7 plus line Z� (3)
Dwelling (4) �
Residential improvements
Garage (5)
Other improvements (6)
Total improvemenis (line 4 through lina � (7)
7otal value (line 3 p�s line 7) " (g)
I hereby certify �he above i5 �rue, CorreCi, and Signature of Assessor Date signetl
complete.
Verityirg action - Sgnature of Auditor � Date signed
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- STANDARD DEDUCTION ALLOWANCE � �
79_Pay79_
Lesser of 7/2 Homestead
valuation or 52.000 S
Signature of AWitor ('� Date si ned
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