Homestead_Linxwiler���� i CLAIM FOR HOMESTEAD PROPERTY TAX ' FORM YEAR
;��� CREDIT/STANDARD DEDUCTION HCio �
,,,�q ,` � State Porm 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side /or filing instructions. . . �
� � � " - -' '� ' CERTIFICATIONSTATEMENT - - � �
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I(We) i2 c (h/ � GU/G- � � certify t o_ .th�-7st- a�o amh, 79_
�) occupied as our principal place of residence the following described rea property for which a Homesiead Pr� Tryc 9re�4' ��ereby claimed: .
(We) owned ❑ Are buying under coniract �� '
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and thai owns ih mperty or i bu ' unde co ract.
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. rl111hT� ��'�}C n
� � - - CONTRACT RECORDED - - � � ,�%!�� ' - �� - -
It buying on contrnct, Fee Simple owners name � ' ,
Recorder's office where wntraa is recorded Record number Page
� - � PROPERTV DESCRIPTION ' - ' �
C nty�I/,/��r . � . T hip� ' Taei(g dist[nN��/j��ry�, row�n, lownship) . _
�!/J O ' ' �' � yYt C. / �-!✓ 1V / Q N'1
Parcel number Legal description ,
C9a S- o S 6- � �
If any portion of the residential stmcWre or the land not exceeding one (1) acre ihat immediatety surrountls �hat swcwre is used m protluce income, tlescribe the use and ponion
of the property u6lized ro produce income.
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G-/?- - -a�3.�.�-��1 '.
- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County TownShip Counry Township
eby certify the above statements are true, correct and complete. Signanre of ciaiman�
Ad ess (number arrtl streef, uty, slat . Z(PCOde)
C �
� ASSESSOR USE ONLY . TRUE TAX � ASSESSED HOMESTEAD � NON-RESIDENTIAL.
VALUE VALUE- VALUE VALUE .
Land not exceeding 7(one) acre immediately ,
surrounding residential improvements. (�)
Other land (2)
7otal land Qine 7 p/us line Z� (3)
Dwelling (4) . . �
Residential improvements �
Garage (5) . �
Other improvements . (6)
Total improvements (line 4 fhrough line � (7)
Total value (line 3 pLs line 7) (g)
I hereby certify the above is Irue, correct, and Si9namre ot Assessor Dace signed
complete. -
Veritying aaion - Signature of Autliror Date signed
� . STANDARD DEDUCTION ALLOWANCE �
79_Pay19_
Lesser of 1/2 Homesiead
Valuation or 52.000 S
� . Dat si netl�—