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��" `; CLAIM FOR HOMESTEAD PROPERTY TAX -
s,�'� CREDIT/STANDARD DEDUCTION � . '
.�` � � State Porm Sa73 (R2! 5-92)
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INSTRUCTIONS: See reverse side !or liling inshucfions.
�- � -� � - " � - CERTIFICATION TA
FORM YEAR
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�„�Av � a 'i�fyd
S m��.� 11�� e .
I(We) � certif that/tin the 1 a ot March, 19
'�) occupied as o r principal place of residence lhe follovring des ri ed real roperty for whic a orr�esi�e.��d Qiop ,T _ i��is hereby Gaimed:
r J !;l'•i:i3! -'
L, I(We) owned ❑ Are buying under coniract � C'°� "� ,
❑ Have a beneficial interest.in ihe entity ihat is liable for the property taxes on ihe property and ihat owns ihe property or is buying under a contraci.
- - �CONTRACTRECORDED--, � . � -- �� . �
If buprig on convacl..Fee Simple owner's name �
Recorder's oftice where contrecl is recorded Record number Page
PROPERTY
Coun,y . . _ Township • Tazing tlistna (ciry,�rown, townshlp�� -
P �cel number Legal descnption
s� - t .,. - 3 -I � � g
If any portion of the residential structure or fhe land nm exceeding one (7) aae thai immediatety sunounds Ihat structure is used [o produce fncome, describe ihe use and portion
of the property utilized to produce income. ,
y.
i ��i�sieirsiiriQi�i�i��r_���� �
�� ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL.
- . .VALUE VALUE. VALUE . VALUE ��
Land not exceeding 1(one) acre immediately � -
surrounding residential improvements. (�) � �
Other land (p)
Total land (line 7 plus line Z� (3) ,
Dwelling (4) . � ° .
Residential improvemenis ' �
Garage (g) � �
Other improvements (6)
Total improvements (line 4 throu9h lina � (7)
Total value (line 3 pVs line 7) (g)
I hereby certify [he above is true. COrrCCi, and Signature of Asseswr Date signed
complete.
Ventyirg action - Sgnature of Audimr Date signed