Homestead_Leister (2)�E O
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side !or �ling instructians.
FORM YEAR
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APR i ? 2Un0
� CERTIPIC TION TATE ENT - )
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I(We) 'FCertifythaz�on h: �d .79_
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I�(We�) occupied as our principal place f residence the owing described real property for which a Homestead Property Tax Credit isfiereby claimed:
�'I (We) owned ❑ Are buying under contract � �
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a co�tract.
. CONTRACTRECORDED
If buying on conVact, Fee Simple owners name � .
Recorders otfice where contract is recorded Record number Page
PROPERTY DESCRIPT�ON
Counry 7ovmship Ta ing disiria (dry, town, township) '
Parcel number Legal de �p6o
� - � « S � � - 3 -// , �7U�,
If arry portion of the resitlential siruc[ure or Ne land rot e ing one (1) acre Ihat immediatety surrounds thai sWaure is usetl ro protluce income, tlescnbe the use and ponion ot
Ne properry utiGzed to produce income.
- � ��- a3o3 r� 3 . �,'99 ��-/
PflOPERTY OWNED BY CWMANT IN OTHER COUNTRIES
Counry Township Counry Township
Sig re of cl '
ereby certity the above statements are true, correct and complete. �
Atltlress (number and street, ciry, slate, ZIP code)
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding 1(oneJ acre immediately (��
surrounding residential improvements.
Oiher land (2) I
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvemen[s (line 4 through line 6) (7)
Total value (line 3 plus line 7J (8)
I hereby certify Ihe abOVe is We, Correct, and SignaWre oi Pssesor Date signetl
complete.
Verifying action - Sgnature oi Audi:or Date signed
STANDARD DEDUCTION ALLOWANCE
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79_ Pay 19 _
Lesser of 1/2 Homestead c�
Valuation or S2,000
Si tur Autlitw, 7 Date signetl
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