Homestead_Midkiffa��' �� s CLAIM FOR HOMESTEAD PROPERTY TAX
3���; CREDIT/STANDARD DEDUCTION
..,�y ,` `• State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side for filing instructions.
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I(We) 1 � . certifyqhat on the 1st day�qf March/,; 79
I(We) occupied as our ipal place of idence the following de r real property for whicha Homestead-Property�Ta�rCred4is hereby,�Gai jd:
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�✓ I(We) owned ❑ Are buying under coniract �L', �a—�� D� '° C-jE8^`' "'f•?�'�"Y ?,l'f]iTGR
�.iave a beneticial interest in ihe emiry ihat is liable for the pmperty tazes on the property and that owns ihe property or is buying under a contract.
� � � CONTRACTRECORDED - �� -
If twying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number � Page
Counry
Pareel number
Township
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T2eiflg tliStriCt (Lity. town, towrtshipJ
If any ponion of the resitlential stmcture or ihe lantl not exceeding one (1) acre thai immediatety surrountls t�at strucnre is usetl to protluce income, tlescribe lhe use antl portion
ot the propeny utilized to produce income. �
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- ASSESSOR USE ONLY ' TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
� VALUE VALUE. VALUE � VAWE ,.
Land not exceeding 1(one) acre immediately � .
surroundinq resideniial improvemenis. (�) .
Otherland (z)
Total land (line 7 plus line 2� (3)
Dwelling (4) .
Residential improvements � �
Garage (5�
Other improvemenis (6)
Total improvements (line 4 through line � (7)
Total value (line 3 pUs line � (g)
by tehify Ihe above is ime. CArrett; and Signature ot Assessor . Date signed
. piete.
Verityirg action - Signamre of Audiror Date si9ned '
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52.000
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Signawre of Autlitor � ' � Date sgnetl