Homestead_Douglas (9)�a�•n
e� " g CLAIM FOR HOMESTEAD PROPERTY TAX
i'�': CREDIT/STANDARD DEDUCTION
.�;�'� State Form 5473 (R2 % 5-92)
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INS7RUCTIONS: See reverse side forliling instruciions.
FORM YEAR
HC —
iA'�D _ � 'loOC
'e) v�1jK).�w) . certify that on the ffift7 /•�
e) occupied as our the foll � ing tlescribed real property for which a Homesiead Property Taz Credi i . Mf , d
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I(We) owned ❑_Are buying under contract - � .
Have a beneficial interest in the entiry that is liable tor ihe property taxes on the property and thai owns the property or is buying under a contract.
- � CONTRACT RECORDED -
It buying on comract, Fee Simple owuer's name _ �. ^ � . , . �
Recortler's oHice where wntract is recorded Record number Page
' PROPERTV DESCRIPTION
Couniy . . Towns ' Taxing di 'ciry, lown. mwnship) - . �
Parcel number L ' escription
5 - O �i� 3-3 = . 30�4 '
It any ponion of Ne residenlial stmcture or the land not exceedirg one (i) aae that immediatey surmuntls that swciure is used ro produce income, describe Ne use and portion
of the properry utilized to produce income.
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ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON•RESIDENTIAL.
VALUE VALUE VALUE VALUE -.
Land not exceeding 7(one) acre immediately
surrounding residential impmvements. (� � ' �
Oiherland �p)
Tmal land (line 7 plus line Z� (3)
Dwelling (4) �
Residential improvements
Garage (5� �
Oiher improvements (6) �
Total improvements (line 4 through line � (7) . .
Total value (line 3 p�s line 7� _ (g)
I hereby certify the above is ime, COrrec[, and Signamre of Assesmr Date signed
complete.
Veritying aciion - Sgnamre ol Auditor Date signed
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