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ti CLAIM FOR HOMESTEAD PROPERTY TAX
' ' `� CREDIT/STANDARD DEDUCTION
a�
,�/� State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side Ior filing instructions.
FORM-
HC70
YEAR
3
1 fWe) ��(J v`^-^ 1 � Y'— L�2 T��LCN�— certi(y th5[ on the tst d-ay of March. 79/ ^
�_.) occupied as our principal place of residence the following described real property for which a Homeste Property TL�yx C�dit is hereby claimed:
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�, I(We) owned ❑ Are buying under contract . . �' AUDITOR �
❑ Have a beneficial interest in the entity that is liable for the property taxes on ihe property and thai owns ihe property or is buying under a con[ract.
� CONTRACTRECORDED � " ��
It Wying on coniract, Fee Simple owner's name -��
Recortler's oHice where contract is recorded Record number Page
County
Parcel number
ODS- �
If any portion of
of the pmperty i
"� PROPERTYDESCRIPTION � - �
TownShip Tirtirg distnci (Gty, tOwn. town5hip)
Legal tlescription
- 0 � `�� %l�� /l� GcI' � ".�—��. .��
�itlenfial stmcwre or ihe tand no1 exceeding one (il acre that immetliatey surrountls that structure is used to produce income, descnbe Me use and portion
to produce income.
ASSESSOR USE ONLY TAUE TAX � ASSESSED HOMESTEAD NON-RESIDENTIAL
- VALUE VAWE VALUE VALUE �
Land not exceeding 1(one) acre immediately `
surrounding resideniial improvemenis. (�)
Otherland (p)
Tmal land (line 7 plus line Z� (3�
Dwelling (4) � � �
Residential improvemenis �
Garage �5)
Other improvemenis (6) �
Total improvements (line 4 thiough line � (7)
Total value (line 3 p�s line � (g)
I hereby certify the above is ime, correct, and Sgnature of Assessor Date sgned
complete.
yirg adion - SignaWre of Auditor Date signed
i