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Homestead_Leistere�e �3 � CLAIM FOR HOMESTEAD PROPERTY TAX i; �;; CREDIT/STANDARD DEDUCTION �,,; • State Form 5473 (R2 / 5-92) �sie � INSTRUCTIONS: See �everse side for /iling insfructions. . � � . - . � �.. I\ ` CERTIFICATI FORM YEAR HC10 A I(We) � rtify that orY[h 1 t day o ar , 79 �) occupi d as our principal place of residence the following described real property for which a Ho y r y claimed: ,(We) owned ❑ Are buying under contract � Cir350N �UtfTY AUDITOR ❑ Have a beneticial interest in the entiry that is liable for the property taxes on the pmperty and that owns ihe property or is buying under a coniraci. �' ` � �- - - � � ���' �� - -CONTRACTRECORDED;' - � �� �- ` - If buying on contract. Fee Simple owners name � ' ,_ Recortler's oHice where contract is recorded Record number Page 11 any port�On oi lhe te51tl ot the pwperty utilized to "� � PROPERTY DESCRIPTION - ' TownShip ' � T ing dist �(dty, tmvn township) � 4 Legal description or ihe land not ezceeding one (7) aue that immediatety surrountls that swciure is usetl ro produce e. c�-ia-v7 iw-u�a. a��-��s ' �- PROPERTV OWNED BY CLAIMANT IN OTHER COUN'fIES Counry Township Counry � S' nature of ��+_�� �eby certify ihe above statemenis are ime, correci and complete. g Address (number and street. dry. sta(e. ZIP code) describe Ne use and portion ASSESSOR USE ONLY .- TRUE TAX "- ASSESSED HOMESTEAD � NON-RESIDENTIAL VALUE VALUE VALUE VALUE , land not exceeding 1(one) acre immediately � surmunding resideniial improvements. (�� � � � Otherland (p) - - Total land (line 7 plus line 2� (3) Dwelling (4) � Residential improvemenis Garage (5) - Oiher improvements . (6) � Total improvements (line 4 through line � (7) 7otal value (line 3 pLs line � (g) I hereby certify the above is Irue, correct, and Signa;ure of Assessor Da;e sgned - camplete. Verityirg aaion - Signamre of Autlitor Date signetl ' STANDARD DEDUCTION ALLOWANCE � 19_Pay19_ Lesser of 1/2 Homestead valuation or 52,000 S Sgnamre ot Autliror Date signed