Homestead_Larkins.+� °'� YEAR
i����, � CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT/STANDARD DEDUCTION HCto
� • State Form 5a73 (R2 / 5-92)
S �
,.�.
INSTRUCTIONS: See reverse side lor liling instructions.
/
. �- -- - -r:CERTIFlCATIOH,STATEAIENT% � ^.'`w� t� ��
giWe) � "/ ! �r �ls�lS'._._.. .. ._.. ... ".. �ttV��{�h-e,.
�Ye) occupied as r principal place of residence the tollowing described real pmperty tor which a Homes� Pr�e�mC
❑ I(We) owned ❑ Are buying under coniract '� j Q
❑ Have a beneticiai interest in the entiry that is liable tor the property taues on the property and that owns th��ert¢ oY is
It buy'ug on contraa, Fee Simple ownefs name
Recortlers oHice where contract is recorded
Retord number
. . .. . ' . . �� PROPERTYDESCRIPTION�.-�" �'�� '
Counry ` Township Tacirg distritt (dry, to �, ownshr �
�6? d�c" �
Parcel number Legal descnption
Do.Y Ov� J-�
If any portion of the residential simcwre or t�e lantl noi exceeding one (1) acre that immediatey sunountls Mat structure is used to produce income,
of the pmperty utilized to produce income.
� � PROPERTY OWNEC
Township
certity the above statements are true, correct and complete.
',number and sJrqet. ary, slate. ZIP code) _ �
—i/o�-i
CLAIMANT IN OTMER COUNTIES
Counry
Township
. , :. _ .: , ,. . .
, a::
. 19_
is hereby claimed:
under acontract.
Page
Ne use arM portion
� ASSESSOR USE ONLY TRUE TAX ASSESSED FIOMESTEAD �� � - NON-RESIDENTIAL. .
- VALUE VALUE VALUE . VALUE ':� ..
Land not exceeding 7(one) acre immediately � �� ° _
surrounding residential improvements. ��) �
- •; ?
Otherland (2) . ' `� `
, a.
Total land (line 1 plus line Z� (3)
Dwelling (a) � _� �� �
Residemial improvements . . �
Garage (g) �- -
Other improvements (6) �
Totat improvements (line 4 through line � (7)
Total value (line 3 p6s line � (g)
I hBreby GeRify ihe above i5 lrue, CorreCt, and Sgnamre ot Assessor Date syned
complete.
��rifyirg action - Sgna;ure of Audi;or Date sgned
i
79_Pay19_
cser of 7/2 Homestead
Valu� or $2,000
SgnaNre of Audiror
$
rl