Homestead_Flenera• ^�°•
E_' � CLAIM FOR HOMESTEAD PROPERTY TAX
s��� CREDIT/STANDARD DEDUCTION
Sta[e Fortn Sa73 (R2 / 5-92)
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INSTRUCTIONS: See reverse side for liling instruttions.
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Z �'�/�R�/ � certify ihat on the 1st day of March, 79—Qj�/�
our princip I lace of residence the following described reai property for which a Homestead Property Tax Credit is hereby Gaimed:
(We) owned ❑ Are buying under contraci
❑ Have a beneficial interest in Ihe entiry that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED �
If buying on contract, Fee Simple owner's name .
Recorder's ofliCe where coniract is recorded Rewrd number Page
COUniy
Parcel numher
c�c�S- �3(��
PROPERTY DESCRIPTION
�t.J �i;� 1(0 - 3 —
town,
If any portion ot the residen,ial swcture or the land not ezceeding one (1) aae that immediarety surmunds that s;rucmre is used ro produce income. describe Ihe use aM portion
ot Ne property utilized to produce incame.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Counry _ Township Counry Township
���eby cenify the above statements are true, correct and complete. Siqnamre claimam
Address (num6er and sbeet, city, state, ZlP code)
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL .
VALUE VALUE VALUE VALUE
land not exceeding 7(one) acre immediately I
surrounding residential improvements. (�)
Otherland (z)
Total land (line 1 plus line Z� (3)
Dwelling (4)
Residential improvements _
Garage (5) I
Other impravemenis (6)
Total improvements (line 4 thiough line � (7)
Total value (line 3 p�s line � (g)
I hereby Certify ihe above is lrue. Correci, and SignaNre ol Assessor Date signed
complete.
Verifying action - Signature ot Auditor Dare signetl
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