Homestead_Straw (3)al�� f CLAIM FOR HOMESTEAD PROPERTY TAX FoRM vEaR
5��;� CREDIT/STANDARD DEDUCTION HCio
�,��� State Farm 5473 (F2 / 5-92)
�7
�efe . . - . .. .. . -
INSTRUCTIONS: See reverse side lor /iling instructians.
e�(Z/�dkj tJ -�L � I�j1n.0� �- ��,►y� certify that on the 7 st day of March, 79�
e) occupied as � principal place of residence ihe tollowing described real property for which a Homestead Property Tax Credii is hereby claimed:
I(We) owned ❑.Are buying under contraci , .
Have a beneficial interest in ihe eniity thai is liable for the property taxes on the property and that owns the property or is buying under a contract.
'� - CONTRACTRECORDED . -' - -
. , ... . .._ .. . . . �
If buying on contraci. Fee Simple owner's name - - . _ _ � �. . .
Recortler's oHice where contract is recortletl Record number Page
Coumy
PROPERTY DESCRIPTION
Tazing tlisuiF( c� , town, township) .
Parcel number Lega e tion _� U.
co�5-�8c�1 °� �.�� �- -t� a_��C
If any portion of the residential stmcture or the land not exceeding one (1) acre that immediatety surrounds that structure is used to praduce income, descnbe Ne use and portion
ot the pwperty utilized to pmduce income.
- _3ao -6G3. 8�/-Q�
PROPERTY OWNEO BY CLAIMANT IN OTHER COUNTIES � ��
County Township Counry Township
��
��eby certify the above statements are irue, correct and complete. Signawre o( ciaimant
Addre,s5 (r}ym\r and s;reet, ciry, state, ZlPmde)
kK
• ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL.
VALUE VALUE VALUE ' VALUE .
Land not exceeding 1(one) acre immediately
surrounding residential improvemenis. (�)
Oiherland �p)
7otal land (line 1 plus line 27 (3)
Dwelling (4) � -
Residential improvements ,
Garage (g� �
Other improvements ' (6)
Total improvements (line 4 through lina � (7) I
Total value (line 3 p�s line 7� (g)
I hereby certify the above is lrue, correCi, and Signa;ure ot Assessor Date signed
complete. '
'�ying action - SignaNre of Auditor Date signed