Homestead_ReevesY`� R�� t CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
r,�� CREDIT/STANDARD DEDUCTION HCto
�iYr.` Siate Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See �everse side Ior tling insfructions.
_ . __...� � - -.., .':.:CERTiFiCA ENT.' � 'r-�w � - .t
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I(We) ify that e st ay r
I(We) i as our principal place of residence the ollowing described real properry or which a Homestead Pro Ta�C�i�i� d ed:
I(We) owned ❑ Are buying under contract �������
Have a beneficial inierest in the entiry that is liable for the property taxes on Ihe property and that owns the property bu in contract.
� � � .:-»,..�..; , ._ . , _ �. . . ..�_' -=�`.�_CONTRACT�RECORDED.-,-. , .... ,,� . .._,..:.( �±, .. ..
� l:�.L..�;.�.�.._:-:. 4:.i1! .
If buyirg on contract, Fee Simple ownefs name`
Recorder's oHice where contract is recorded FiecoN numDer Page
.. . -. . � . .�.. ,., � ,r,� � -° .PROPEH'TYDESCRIPTI = .�..� , a ..,s_, -s;�._ . . . . .
Counry Towns�ip Taxing dist �( , fo n, to ship
� /� ./. .
If any portion of ihe residential s�truaure or the land not exceeding one (1) acre Ihat immediatety surrounds that swcture is used tdpfoduce income, tlescribe ihe use arW portion
ot the property utilized to produce income.
c��-//-/7- � -Qo% �70- o�/ ',. . ,.
�' ' PROPERTY OWNED BY CLAIMANT.IN OTHER COUNTIES�� � �
Caunry Township Coun TownShip
I hereby certify the above statements are irue, correct and complete. Si re of c� na � 1 e
dX �'�
=5 (number and slreet, city, s(ate, Z/P code)
(` 1 �� �� �
� . TRUE TA% ASSESSED HOMESTEAD .' NON-RESIDENTIAC ..
�����ASSESSOR�USE ONLY ', ' VpLUE . VACUE �VALUE ��. � +� VALUE . � �
Land not�exceeding 7(one) acre immediately : , � -
surroundingresidentialimprovements. (�) s�"- ��
Otherland (p) ��� �r �
Tolal land (line 1 plus line Z� (3)
Dwelling (4) � . . - ' ` =� . �.
�,
Residential impmvemenis . . _
Garage (5) .. .. ..
Other improvemenis (6) � �
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line � (g)
I hereby certify ihe above i5 true, cOrrect, and Sgnature of Assessor Date signed
complete.
Ventying action - Signature o; Audiror Dare signed
_
- � � . STANDARD DEDUCTION ALLOWANCE :' �' " .'s,:,
79_Pay19_
Lesser of Homestead
/Jal, on or $2,000 , /'%J $
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