Homestead_Presnelle�� �� a CLAIM FOR HOMESTEAD PROPERTY TAX
���� CREDIT/STANDARD DEDUCTION
�:;� State Form 5473 (R2 / 5-92) � .
• aii `� � �
INSTRUCTIONS: S��e si �for liling instructions.
FORM
HC10 .
YEAH
I (We) V1 ✓/KJU-�> >E'J _7 /(f�TLQ. /�l� certirySR9tlfiTne �sttlajAbt March, 79
�) occupied as our principal place of residence the following described real pmperty for which a Homesiead Property Ta�c Credii is hereby daimed:.
i ; ! �;�
LI I (We) owned ❑ Are buying under comract -{ , �— _r �' � %�
�. . -c.�._...,, �r� h) ::o� `:
❑ Have a beneficial interest in the eniity that is liable for ihe property taxes on the property and ihatbwn�;it�pqp�e"tty o�is.buyj�� e a contraci.
� � � - � �.. CONTRACT RECORDED � � � - - - � - '
If buying on coNract, Pee Simple owner's name - - .
Remrdefs oftite where conlracl is recorded . Record number Page
County
Township
Parcel number Legal de:
oos -�� o �a-�
If any portion ot the residential stmcNre or the land not
ot Ne pmperty utilizetl to protluce income.
(1) 2G2
/�
DESCRIPTION
Tacing di5vi41�(
y-3-!� �. ��o �c
surmunds �hat siructure is used ro produce income, describe t�e use antl portion
�G�—���
PROPERTY OWNED 8Y CLAIMANT IN OTHER COUNTIES �
Counry Township Counry Township
�eby certity the above statements are irue, correct and compiete. Signam e ot daimam
Atldress (numberandstreel, city, slafe, ZlPmde) .
ASSESSOR USE ONLY � TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
. VALUE VALUE VALUE VALUE
Land not exceeding t(one) acre immediatety � -.
surrounding resideNial improvements. (�) �
Otherland (p)
Total land (line 1 plus line 7) (3)
Dwelling (q) .
fiesidential improvements _ �
Garage (5)
Oiher improvemenis (6)
7otal improvements Qine 4 through line � (7)
Totai value (line 3 p�s line � (g)
I hereby certify ihe above is tme. correci, and Signature of Assessor Da;e signed
complete.
V=.itying action - Signature oi Auditor Date siqned
79 _ Pay t9
Lesser of 1l2 Homestead
Valuation or 52.000
STANDARD DEDUCTION
S
Date