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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fonn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side /or liling instructions.
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CERTIFIC TION STATEMENT ' �
�Je) �ify that on U�e�4�/ day o � 79_
I(We) occupie s our �ncipal place of residence the follo g described real properry for which a Homest d Prope` "lTax t,Yedit�i���iy daimed:
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❑ Are buying under contract GIBSOn �
❑ Have a beneficial interest in the eniity that is liable for the property ta�ces on the property and that owns the property or is biiying under a coniract.
CONTRACT RECORDED �
It buying on conVacl, Fee Simple ownels name �
Recortlers otfice where contract is recorded - Record number Page
PROPERTY DESCRIPTION
Counry 7ownship ' Ta<ing district (ciry, town, township) -
Parcei numbery� L deuription /�^''�
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If any portion of the resitlenfial structure or the land not exceetling one (1) acre ihat immediatety surrounds that strucmre is usetl ro protluce income, describe the use and ponion of
the DroPerry utilizetl ro praduce income.
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PROPERTY OWNED�BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
g r o daimant .
�ereby certify the above statements are true, correct and complete.
ntldress (number and slreet, ciry, state, ZIP wde)
ASSESSOR USE ONLY - TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTtAL
VALUE VALUE VALUE VALUE
Land not ezceeding 1(oneJ acre immediately (�� ,
surtounding residential improvements. -
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvemenis
r
Garage (5) �
Other improvements (6)
Total improvemenis (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, Correct, and Signature of Assesor Date signed
complete.
Vedtying action - Signature ol Auditor Date sgnetl
STANDARD DEDUCT70N ALLOWANCE
19_ Pay 19 _
Lesserof 1/2 Homestead � _
Valuation or $2,000
Signature ot Autlrtor Da[e signed