Homestead_Fireline`�� CLAIM FOR HOMESTEAD PROPERTY TAX
i � CREDIT/STANDARD DEDUCTION
SWte Form 5473 (R2 / 5-92)
�'+�i =
INSTRUCTIONS: See reverse side lor /iling instructions.
FORM
HC70
YEAR
�Je) G T�./ �l �,�f.� V ULF: �� certity that on kl�o 1st �a$oftl��, 79_
Je) occupied as our principal place of residence the following described real property tor which a Homestead P rty Tau Credit i� e y daimed:
❑ I(We) owned ❑ Are buying under contract ��
_��..}.:�
❑ Have a beneficial interest in the entiry that is liable for ihe property taxes on the property and that owns the pro��611Js;4u.y�n�und'`e� ITOR t
- _.CONTRACTRECORDED.� - � �� - --
If bryirg on contract, Fee Simple owner's name
Recorder's oftice where wmraa is recorded Recortl number Page
TownShip
8 .. � _ . '
Py�(pup6ei�� I Legal descri� ion� ti ` � � /� /, �� „/ � � / ,
lNJ yV i� , � ll
II any ponion of the resiaential stmcture or Ihe lantl not exceeding one (7) acre t�at imm latety surrounds that struciure is used to produce income.
ot t�e pmperty utilized ro produce income.
„?/__ /%��a��-c�o.Oda-O�i
the use and portion
PROPERTY OWNED BY CLAIMANT IN OTHER�COUNTIES ` �
Counry Township Counry TownsNp
� reby certity the above statements are tme, correct and complete. Si amr daiman2
���x
Cdr n mber and sbeet ciry, state, Z/P code)
/L o z r� � owPnS�/��llf v Y�C�6�
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL �
� . - - VALUE VALUE VALUE VALUE �-
Land noi exceeding 7(one) acre immediately I , �- �
surrounding residential improvements. (�� �
Other land (p) ���' � ' � {�` � ,
7otal tand (line t plus line Z� (3)
Dwelling (4) � . .
Residential improvemenis .
Garage (g) � - -
Other improvements (6) �
Total improvemenis (line 4 through line � (7)
Total value (line 3 pbs line � (g)
I hereby certity ihe abOVe is true, correct, and Signature ot Assessor Dare signed
�mplete.
�iipng action - SignaNre of Auditor Date syned
STANDARD DEDUCTION ALLOWANCE" : _ -
19_Pay19_
Lesser of 7/2 Homestead
Valuation or 52.000 5
- Date signpq /� �� 1
�� ,v��