Homestead_Loftoneaa ,*.p
;,��; CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
�;/�� State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side for /iling instructions.
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MAY 101993
� � � - - � -0ERTIFICATION STATEMENT • � � (�('iybnqJ /CT , 0/ ,$
I 1We) _ I certify thai on the lst day of March, 79�
�5) occupied as our princi I place of residence t tollowing described real property for which a Homestead Pmperty Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract , .
❑ Have a beneticiai interest in the entity that is liable for the property taxes on the property and ihat owns the property or is buying under a contraci.
� CONTRACT RECORDED .
IIf buying on contract, Fee Simple owner's name . -
' Recortlefs ottice w�ere contract is recortled Record number Page
" PROPERTY DESCRIPTION - � �
Counry ._ Tow s� Taxing district (pry, 1own, township)
Parcel .um r Legal iption
OOS- -0 -� 1J St �f-(-Io� I��LE�-�
It any ponion of ihe residential structure or the land not ezceetling one (11 acre ihat immediatety surrounds that sWCWre is used to produce irwome, descnbe the use and ponion
ot the properry utilized ro protluce income.
�
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
Counry Township - Caunry Township
�eby certify the above siatements are true, wrrect and complete. wre aimam
�
r (numbei and sneeL ciry, state, Z/P oode)
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
� VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately
surrounding residential impmvemenis. (�) �
Otherland (p)
Total land (line 1 plus line � (3) I
Dwelling (4) � ,
Residential improvements -
Gara9e (g) �
Oiher improvemenis (6)
Total impmvements (line 4 thiough line � (7)
Total value (line 3 p�s line � (g)
I hereby cenify ihe above is irue, correct, and Si9nature of Assessor Date signetl
complete.
�tyirg aaion - Signa:ure of Autlitor Date signed
19 _ Pay 79
Lesser oyTy2 Ho/f
or
STANDARD DEDUCTION
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of Autlitor ' / ��/ I vare slqr�ea
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