Homestead_Short (2)�E O
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Form 5473 (R2 / S92)
INSTRUCTIONS: See reverse side Ior filing instructions.
FORM
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YEAR
CERTIFICATION STATEMENT �,
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I(We) 1 (lY� `��ceitirytha(onihe;7sidayofMarch,l9_
I(We) occ ed as our principal place of residence the followin9 described real property for which a Homestead Properry Tax Credit is hereby claimed:
❑ I( e) owned ❑ Are buying under coniract �
❑ Have a beneficial inierest in the eniity that is liable for the property ta�ces on the property and that owns the property or is buying under a contract.
CONTRACTRECORDED
If buying on convact, Fee Simple ownefs name
Recorders o(fice where contmct is recorded � Record number Page
PROPERTY DESCRIPTION
Counry Tovmship Taxing tlisirict (dry, town, fownship)
Parcel number Legal scription
Co5 -� 1�'�1 S� �S � O- �- I 1
If arry ponion of Ihe residential swtture or the IarM not exceetling one (1) acre that immediatery surtountls ihat stnsture is used to protluce income, tlescnbe the use antl portion of
Ihe properry utiiized to produce income.
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
i
ignatur o imant_ �
ereby certify the above statements are We, covect and complete. ` /
Address (number and streeG dty, s(a(e, ZIP code)
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding t(one) acre immediately �� �
surtounding residential improvemenis.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dweiling (4)
Residenlial improvements
Garage (5) "
Other improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7J (8)
I hereby certity the above is true, correct, and Signawre ot Assesor oate signed
complete.
Venfying ac6on - Signamre of Autlitor Date signed
� STANDARD DEDUCTION ALLOWANCE
79_ Pay 79 _
Lesser of 1/2 Homestead y
Valuation or 52,000
Signamre of AWitor Date signetl