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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side �or �ling instructions.
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AU6 0 9 1999
CERTIFICATIO ATEME - � �
I (We) certity a�� a ���
I(We) occu i d as rincipal ce of resi e e the following scribed real.property for which H mesiead Property Tau Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract . _ , , , -
❑ Have a beneficial interest in ihe entity that is liable for the property tares on the property and that owns the property or is buying under a wntract.
CONTRACTRECORDED � -
II buyirg on contract. Fee Simple rnmels name
Recrordels oHice where conVact is recortled Fecord number Page
PROPERTY DESCRIPTION
Couniy TownsNp Tadrg tlistrict (ciy, lown, township)
r u �� Legal description � 3� a
any portion of the resitlential swcture or the land not exceeding one (1 � acre that i etliatey sunountls that swcture is used ro produce income, describe the use and ponwn ot
the property uu7ize4 to produce income.
oT�- ��3 - cv - oa�. �/9� O�.i-
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Coun Township Counry Township
�ture o im t
reby certiry the above statements are true, correct and complete.
dress (numberand sireet, ciry, state, Z/P code)
� R i oY < <�s ;(c T� 47�o(oS`
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediatery (� � .
surrounding residential improvements.
Otherland . (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 through line 6J (7)
Tofal value (line 3 plus line 7) (8)
I hereby certify the above is true, cortect, and Signamre oi Assesor Date signed
wmplete.
Veritying acuon - SignaWre of Auditor Da[e signetl
�' STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser o 1/2 Homestead r� '
V tion or 52,000 .
Sgnamre of Auditor Dat ned