Homestead_McGillemsr rF
CLAIM FOR
CREDIT/STANDARD HOMESTEAD
DEDUCTION PROPERTY TAX
'lam State Form 5473 (R2 15-92)
INSTRUCTIONS: See reverse side for filing instructions.
1 i\
!FORM`"Z2i YEAR
ma
CERTIFICATION STATEMENT
I (We) certify that on the 1st day of March, 19_
I (M e) occupi as our principal place of resid nce the following described real property for which a Homestead Property Tax Credit is hereby claimed:
e) 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 contract, Fee Simple owner's name
Recorder's office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township
T district (cl
, town, township)
Parcel number
Legal description
q
00( - -C) t-C
If any portion of the residential structure or the land not exceeding one (1) acre that immedlotely surrounds that structure is used to produce income, describe the use and portion of
the property utilized to produce income.
/
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
Signature of claimant
ereby certify the above statements are true, correct and complete.
-
Address (number and street, city, state, ZIP code)
I go X C15co7 14476
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON-RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
_
I hereby certify the above is true, correct, and
Signature of Assesor
Date signed
complete.
Verifying action - Signature of Auditor
Dale signed
. STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead S
Valuation or $2,000
Signature of Auditor
Date signed