HomeMy WebLinkAboutHomestead_Klusmeier�`��-� ; CLAIM FOR HOMESTEAD PROPERTY TAX
����� CREDIT/STANDARD DEDUCTION
�.�, � State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side lor /iling inshuctions.
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��--.�,o C .L U S` 7Y7G / e 2 /�-"c@. i y�irL�7_ '.�. �,n�TnR �
I(We) �- v�� � � �_that;on ihe tst da of �March, 79_
�) occupied as our principal place of residence the following described real property tor whicha Homestead Property Tax Credit is hereby Gaimed:
�, (We) owned ❑ Are buying under contract� . ,
❑ Have a beneficial interesi in the entiry that is liable for the pmperty taxes on the property and that owns the property or is buying under.a contract.
� � � CONTRACT RECORDED " - � " -
It buying on coniraa, Fee Simple owner's name _ . �-�
Recortler's ottice where contract is recorded Record number Page
County / ( �
I
Parcel number
_O -C
If any portion of R
of Ne pmperry uti
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PROPERTY DESCRIPTION - � _
� Taxing district ( y, town,
�75�-6� � �
ddenlial structure or the IaM not exceeding one (7) aue Nat immediatety surrounds ihat struc[ure is used to produce income. Oescrihe Ne use antl portion
[o produce intome.
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
Counry Township Couniy Township
�by cehify the above statemenis are irue, correct and complete. Sgnawre o� ciaimant -
dress (numberandslreel, ury. stare. ZlPCOde)
ASSESSOR USE ONLY . TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediatety �
sunounding residential improvemeNS. (�) �
Otherland (p)
Total iand (line 1 plus line 2� (3)
Dwelling (4) �
Residential improvemenis �
Garege (5)
Oiher improvements (6) � � �
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line � _ (g)
I hereby certify the above is irue. correCt, and Signamre of Asseswr Date signetl
complete.
Ventying aciion - Signature of Audimr Date signed