Homestead_Lamey�,,, R.,, -
�� i CLAIM FOR HOMESTEAD PROPERTY TAX
3��: CREDIT/STANDARD DEDUCTION
�:% � State Form 5473 (R2 / SA2) �
iau ' . . .• . . .
INSTRUCTIONS: See reverse side lor /iling instructions.
FORM
HC70
� �
Counry ' Township - ' Tawng distr (qty, t wn, t wr
�1 r
V��l/ �/ I lv( I 'l�aldescnption
� l`!
It any portion of the residential stmcture or the land not exceeding one (1) acre ihat immediatety surmunds that struc[ure
of the property utilized to produce income.
Counry
- /7-4/-��CY -'UQ 3 .' yS�e� -D�/
PROPERTY OWNED BY CIAIMANTAN OTHER COUNTIES
Township Counry
eby certify the above siatements are true, correct and complete. �/
7��
.Qdtlre s number aiM streef. dty, slafe, LP code)
_ �b• /3cv� f��� ��e.o.r�;//c 2.J
ASSESSOR USEANLY TRUE TAX
VALUE
Land not exceeding 7(one) acre immediately
surrounding residential improvements.
Other land
Total land (line 7 plus line �
Dweiling
Residential improvements
Garage
Other impmvements
Total improvemenis (line 4 through line �
Total value (line 3 pLs line 7)
I hereby certify ihe above is ime. correct, and
complete.
VeNying action - Sgnature of Auditor
(�)
IZ)
(3)
(4)
(5)
(6)
PJ
(8)
Signature otASSessor
of
ASSESSED
VALUE
produce income, describe Ihe use antl portion
HOMESTEAD
VALUE
Township
NON-RESIDENTIAL.
VALUE
Dare signed
Dare signetl
,