Homestead_Pegram (2)a��''� ; CLAIM FOR HOMESTEAD PROPERTY TAX FoRM YEAR
3��': CREDIT/STANDARD DEDUCTION � riCio
�;;� StateFOrm5473�R2/5-92)
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See reverse side loi liling instructio s. ��
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f�We) _I .[ / /�/" — � certify ihat on Ihe lst day of Mamh, 79_
v
' .) ��ed as our principal place of residence ihe tollowing described real prope r which a Homestead Pro ert Tax Credijt �is her�ejb''y �daimed:
l I (We) owned ❑ Are buying under coniract � � _ -, � �� � L4d ' �� }]
. ���� ' I�
❑ Have a beneticial inierest in ihe entiry ihat is liable for�the property taxes on the property and thai owns the pro �rty s � knid�'atontract.
It buyirg on wniract. Fee Simple owner's name
Recorder's oNice where convact is recorded
Counry . Township
PROPERTY DESCRIPTION
i _
r ��/")/� Odegaldescription / '' � r%/ � '
� I � ( ���SJ
u any portion of ihe residential simcwre or the land not exceetling one (p acre that immediatety surmunds that struc[ure is usetl
of Ne pmperty utilized to produce income.
7-�J3= %dO-
Record number
Page
the use and portion
PROPERTY OWNED BY CLAIMANT IN OTMER COUNTIES �
County Township Counry TOwnship
by certify the above statements are true, correci and complete. Sgr re o� c�aiman2
Address �number arrd street, pry, state, ZlPmde)
� 5a
� ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTtAL
VALUE VALUE. VALUE VALUE
Land not ezceeding 1(one) acre immediately .
surrounding residential improvemenis. (�)
Oiherland (p)
Total land (line 7 plus line � (3)
Dwelling (4) .
Resideniial improvements
Garage (5)
Oiher improvemenis (6) �
Total improvements (line 4 through line � (7�
Total value (line 3 p6s line � (g)
I hereby cenify the above is ime, wrreci, and Signawre ot Assessor oare signed
complete.
„�fyirg action - Signawre of Autlitor Date sgnetl