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o4�`s'""°< CLAIM FOR HOMESTEAD PROPERTY TAX , - '.�pppM � f° ,�'� R
� ° CREDIT/STANDARD DEDUCTION
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INSTRUCTIONS: See reverse side /or filing instructions. - . -,
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-�, - CERTIFICATION STATEMENT - �d �` "'' ;'- " '
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I(We) � 1 certify that on the 7 st day of March, 19_
pppI(W,,,��-e) occupied as our pnncip pl of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
�(We) owned ❑ Are buying under contract ' �
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
- CONTRACT RECORDED �
If buying on crontraci, Fee Simple ownefs name
Recorders omce where coniract is recorded � � Flecord number Page ,
PROPERTY DESCRIPTION
Counry Township Tazing disirict i. town, township) �
Parcel number Legal descnption
� b� ' ( `I3- , .
If any portion of the residential sWCture or the lantl not exceeding one (1) acre Ihat immediatety surrounds that sVUCmre is used ro produce income, describe the use and portion of
the property ufilized to produce income.
/�/�- -c��/�3-C�/ �
PROPERTY OWNED BV CIAIMANT IN OTHER COUNTRIES
Counry Township . Counry , Tovmship
- Signature of clai nt .
�:reby certity the above_statements are true, correct and complete.
Addreu numberantls7reeCciry,stare,ZlPcode)
ASSESSOR USE ONLY TRUE TAX , ASSESSED HOMESTEAD NON-RESIDENTIAL
VAIUE VALUE VAWE VAIUE
Land not exceeding 1(one) acre immediately (��
surtounding residential improvements.
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage -(5)
Other improvements (6) �
Total improvemenis (line 4 through line 6J (7)
Total value (line 3 plus line 7J (8)
I hereby certify the above is true, correci, and Signawre of nssesor oate signea
complete.
Verifying actlon - SignaWre of Autlitor Date signetl
STANDARD DEDUCTION ALLOWANCE
� 19_ Pay 19 _
Lesser of 1/2 Homestead �
Valuation or 52,000
Signature of Auditor �/ Date signed
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