Homestead_FisherST�TE
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form Sa73 (R2 / S92)
INATRUCTIONR� Ree reverse side /nrllinn inclmc�inna
FORM YEAR
� HC1
APR .
, CERTIFICATION STATEMENT ^
I (We) � 0 19_
I(We) place of r i nce the following described real property for which a Homes ea�f���C�6iit�,i&diA�9LA�6y daimed:
❑ I(We) owned ❑ Are buying under contract �
❑ Have a beneficial interest in the entity that is liable for the property taues on the property and that owns the'properry or is buying under a contract.
CONTRACTRECORDED �
It buying on contract, Fee Simple owners name .
Fecortlers oH'ce where conVact is recorded Record number Page
PROPERTY DESCRIPTION
Coun Township Ta�dng distriq (tiy, t , t shi
P cel number O�O �� Legal tlescription � Q'n [� /�_/
(J✓J � vy C �
II any portion ot the residenlial StruMUre or the lantl not exceeding one (1) a re Ihat immedia[ely surrounds ihat sWC[ure is usetl to protluce income. tlescnbe Ne use antl portion of
ehe Oroperty utilizetl to protluce income.
a?L- %O - - � . - D�/
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry . Township
Siq re oi imant
��ereby certity the above statements are true, correct and complete. '
Atltlress (number and street. dry, state, ZIP code)
o il c►'�S U � +� �c
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (�)
surrounding residential improvements.
Oiherland (2)
Total land (line 7 plus line 2) (3)
, Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 lhrough line 6J (7) `
Total value (line 3 p(us line 7) (8)
1 hereby ceNty the above is true, correct, and Signamre of Assesor Date signed
wmplete.
Veri(ying acUOn - Signature of Auditor Date si9ne0
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _ � ,-
Lesser of V2 Homestead �
Valuation or S2,000 �
Si e of Autlito Date ed
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