Homestead_Pegram (3)�,..,.,�
a/^' { CLAIM FOR HOMESTEAD PROPERTY TAX
_:����.��rp.� CREDIT/STANDARD DEDUCTION
- ,ccwy:! � Siate Form 5473 (R2 / 5-92)
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^ INSTRUCTIONS: See reverse side7or7iling instructions.
69 � � !�� �
'a (� ��97. YEAR
D C' `H�10
� �;y�1`�✓�•.-n7GR .
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�Q�691 �! certify ihat on.the tst day of March, 19
�) occupied as o principal place of residence t e followi cribed real property for which a Homesiead Property Taz Credit is hereby daimed:
'(We) owned ❑ Are buying under contract , �
❑ Have a beneticial interest in the entity that is liable tor the property tazes on the property and ihat owns the property or is buying under a coniract.
. �. �-, .-,': :. �.- . . . - CONTRACT RECORDED : . ,- ...'"�- � . . .
If buying on coniract, Fee Simple owner's name - � �
Recordefs office where contract is recorded Record number Page �
County. _ Township � Tacing di�(riti (city, fown, township) • � _
0\ 1 O'lti.n
Parcel number Legal description
If any portion of the resitlential sirucmre or ihe lantl not exceeding one (1) acre that immetliately surrountls Nat structure is usetl ro produce income, describe ihe use antl portion
ot ihe properry utilized to produce income.
� l/O ' � � �!/O�/� Vo�-�
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Gounry Township County Townsttip
.�eby certify ihe above statements are true, correct and complete. amre o� daimant
Atltlress (num6eranOSheet, ciry, stafe, ZlPcode)
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
- VALUE VALUE VALUE VALUE �
Land not exceeding 7(one) acre immediately
surrounding residential improvements. (�) - � '
Otherland (p)
Total �and (line 1 plus line 2� (3)
Dwelling (4) �� . � -
Residential improvements �
Garage (5) �
Other improvements (6) �
Total improvements (line 4 through lina � (7)
Total value (line 3 p�s line 7� (8)
I hereby certify the above is true. CorreCi, and Siqnature oi Assessor Da;e signetl .
complete.
Venfyi(g action - Signamre of Auditor Dare signed
- STANDARD DEDUCTION ALLOWANCE '
79 Pay 79 _
Lesser of V2 Homestead
- Valuation or 52.000 S
SynaNre of Auditor Date signed