Homestead_Stone (3)�,y!*��R
' aE `� a CLAIM FOR HOMESTEAD PROPERTY TAX
a��: CREDITISTANDARD DEDUCTION
�,�`� State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reve�se side /orliling instructions.
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� � - FORM YEAR
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eTnTCUCUT . . '
.e) �lQ��� R orn ).l�ct �1�,��g certify thai onthe 1st day of March. 79_
) occupied as our principal place of residence the tollowing describedreal property for which a Homest���y T�c Crr�j�r�by claimed:
❑ I(We) owned ❑ Are buying under coniract � _ AUDITOR O,
❑ Have a beneficial inieresi in the entiry that is liable tor the property ta�ces on ihe pmperty and thai owns the propeny or is buying under a contracl ,
CONTRACT RECORDED �
If buying on contract, Fee Simple owner's name . . � � . ' � � '� � � . ,
Recorder'S oflice where Crontract is reCorded Record number Page
Counry I Township
� �`.3-1Fs�9 �
Parcel num6er I Legal description
� ou of tne resaential stmaure or the land not exceetl
of ihe property utiiized to produce income.
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PROPERTY DESCRIPTION
town, township)
one (t) acre that immediatey surrounds that structure is used ro protluce income, describe the use and ponion
-4D 3.
� PHOPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County Township Caunty Township
�eby certify the above siatements are true. correct and complete. Signature�aiman`t C _
q.��` J
Address (numberandstreef. ary. state. ZlPpode) -
ASSESSOR USE ONLY
Land noi exceeding 7(one) acre immediately
surrounding residentia�.improvements.
Otherland
Total land (line ] plus line Z�
Dwelling
Residential improvements
Garage
Other improvements
Total improvements (line 4 through lina �
Total value (line 3 p�s line �
I hereby certify the above is tme. correct, and
complete.
��yirg action - Syna;ure of Audiror
79_Pay79_
Lesser of 7l2 Homestead
Valuation or $2,000
TRUETAX ASSESSED
VALUE VALUE
(�)
Iz)
(3)
(4)
(5)
(6)
1�)
I8)
oi Assessor
STANDARD DEDUCTION ALLOWANCE
S
HOMESTEAD NON-RESIDENTIAL
VALUE VALUE ,
N
Date signed
Date siqned
�.0
signetl
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