Homestead_Gottman{ R�� • .
a% � g CLAIM fOR HOMESTEAD PROPERTY TAX
ie�� CREDIT/STA�dDARD DEDUCTION
�.;;� State Form 5473 (R2 / 5-92)
uu .
INSTRUCTIONS: See �eveise side forliling insfructions.
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1 , 1�
YEAR
� �We) _ � {/ � / � at}orrthA�f'st da'"`oYMarch, 79
Y
'�) occupied as our principal place of reside he following described real property for.which�a Hd'mesiead Propeny Tax Credit is hereby daimed:
❑ I(We) owned �❑ Are buying under coniract � �
❑ Have a beneticial interest in the entity ihat is liable�for ihe property taxes on the property and ihat owns ihe property or is buying under a contract.
- � . � - � CONTRACT RECORDED - � � �
I( buying on contract, Pee Simple owner's name� - � � �
Recorders oHice where contract is recordetl Record number Page
County
Township
rown, fownship) .
t
P�elFymbL , �D � Legaldescription , /'�� � ^� ��� ?
C�J'CJ IJ �� n
tl any portion of the residential stmcture or ihe land not exceeding one (1) aue ihat immediately surrounds that struc[ure is used t
of the property utilized ro produce income.
_.q.,�. 07�- GoZ-/
use and portion
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
County Township Couny Township
leby certify the above statements are true, correct and complete. Signamre Gaimam
Atltlress (num6er arrd sfreei, city, sfafe, Z/POOde)
G ow
ASSESSOR USE ONLY - TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately -
surrounding residential improvements. (� � '
Otherland � (p)
Total land (line 1 plus line 2� (3)
Dwelling (4) _
Resideniial improvements
• Garage (5)
Other improvements (6)
Total improvements (line 4 through line � (7)
Total value (line 3 p6s line 7� (g)
I hereby certify ihe above is true. correct, and Signature of Assessor oate signed
complete.
�Ying action - Sgnature ot Auditor Date sgned
79_Pay19_
Lesser of tl2 Homestead
valuation or 52.000
S
ALLOWANCE
SignaNre ot Autliror �� , ^ I DatG s!ppea ��^
y `'`/ IOC I
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