Homestead_Jones (2)�'����"°- CLAIM FOR HOMESTEAD PROPERTY TAX
�; ` � CREDIT/STANDARD DEDUCTION
�� �o State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side (or (ling instructions.
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CERTIF7CA N STATEME -
I(VJe) t on th d y arch,
I(We) occupied as our principai place of residence the following described r property for w a Homestead p����c i' r�
_❑ I(VJe) owned ❑ Are buying under contract , .
� Have a beneficial inierest in [he eniity that is liable tor the pmperty taues on ihe property and that owns the property or is buying under a contract.
� CONTRACTRECORDED �
If buying on cronVact, Fee Simple owners name
1
Recorders oftice where contract is recorded � Record number Page
PROPERTY DESCRIPTION
Counry Township Taung distriq (ciry, town. fownship)
P I um�—��� Legaltlescription � � � . � —�— � ^ � �� .
C.J� /
It arry portion of ihe residential structure ar ihe land not eaceedin one (7 ) acre Nai imm�arey surrountls thai swcture is used to produce income, descnbe Ne use and portion of
the propeny utilizeA to protluce income. _
�'�- /7- O- 00- . � - G�-/
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County Tovmship . Couniy Township
' nature of claimant
I hereby certify the above statements are true, correct and�complete.
Addre (numbera st2et. ciry, stare, Z/Pcotle
18 � �e .�-{%%6S
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
•nd not exceeding 7(one) acre immedialely (�) �
I surrounding residential improvements.
Otherland (2) �
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvemenis
Garage (5)
Other improvements (6)
Total improvements Qine 4 through line 6) (7)
Total value (line 3 plus line 7J (8)
I hereby CeRify lhe above is true, correCt, and Signature of Assesor Date signed
complete.
Veritying action - Signature of Autliror Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead � S
Valuation or S2,000
��ature of Autliror Date signed
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