Homestead_Roberts (4)� t CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
a,�� CREDIT/STANDARD DEDUCTION HC�o
State Form Sa73 �R2 / 5-92)
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_ INSTRUCTIONS: See reverse side lor liling instmctions. � 1 1 l� ���� .
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. . . �- " � � "'^ CERTIFtCAT10N TEMENT::. ' , �•. : �� - :•. - • '" .� . .
- - : L�j� .� IJSJ., _ _
1(We) certity tiiat on Ihe 1st�day of�March, 79_
�ie) occu as o r p cipal pl e f residence the following describ real property lor wFrch a Homestead Property Tax Gedit is hereby daimed:
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I(We) o, ed ❑ Are buying under contract „ r���,,.,. �
I❑ Have a beneficial interesi in the entity that is liable tor the property taxes on the property and thai owns the property or is buying under a contract.
� - - - .. CONTRACTRECORDED ":• .�. � w:� �i.: `:. s;��::.- � --
It buying on contran, Fee Simple owner's name
Recortler's ottice where contract is recorded Record number Page
Counry I Township
Parcel number L al dev
�DS -��5� �
I any port� ion of ihe re5iden6al S(Ndure o( the IarM not �
of the pmperty utilized ro produce inwme.
ao ir-�a- �
P
Counry Township
' PROPEHTY DESCRIP'T10N. �- �
Tazing district (cip; town, township)
one (1) acre
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�reby certity ihe above statements are true, correci and complete.
Address (number and s(reet. dry. sfate, ZIP code)
� i OD� � li�v /07 n..__.....
. , � , ASSESSOR USE ONLY .
land noi exceeding 1(one) acre immediately
surrounding residential improvements.
Oiher land
Total land (line 7 plus Irne 7�
Dwelling
Residential improvements
Garage
Oiher improvemenis
Total improvements (line 4 Ihrough line �
Total value (line 3 p�s line �
I hereby certify the above is irue, correct. and
complete.
�arifyirg adion - Sgnamre of Auditor
19_Pay19_
Lesser of t/2 Homestead
Valuation or 52.000
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surmurids ihai snvcNre is used ro pmduce income. descrihe Ne use aM portion
CWMANT IN OTHER COUNTIES
claimani
TRUETAX I ASSESSED
,VALUE � VALUE�.
1�)
(2)
(3)
(4)
(5)
(6)
(�)
l8)
Signacure
S
HOMESTEAD�
VALUE
a��.._ .. ..
s
NON-RESIDENTIAL,� .
VALUE
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�ate signed
Date signed
Date; netl