Homestead_Weberaa ��R°, CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
i���� CREDIT/STANDARD DEDUCTION HC�o 5
�;;� State Form 5473 (R2 / 5-92�
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INSTRUCTIONS: See ieverse side lor (iling instructions.
� ��Ne) _ _ _ _ _ _ �/vL, certify ihat on ih � y Ma h 9
�) occupied as our princi I place ot residence the (ollowing described real property for which a Homestead Property T re�it i h r y �
�
� I(We) owned ❑ Are buying untler contract . ���\rP C Q �p(��
❑ Have a beneficial interest in the entiry ihat is liable for the property taxes on the property and ihat owns ihe propeny or is 6uy�ng unde�'a do7iiia2t.
If buying on conlracL Pee Simpie owner's name
It any ponion <
of Ne property
contraci �s recortletl
Tawnship
� n� , _ _ legai description
to
CONTRACTRECORDED
number � Page
DESCRIPTION
Taxing distri �
or the lantl not ecceeding one (1) aae that immediatey surrounds that sWCNre is usetl ro produce income, descnbe ihe use a�M portion
' l S? o?Do � �3. ��/- ��/
� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Counry Township County Township
�eby certify ihe above statements are true, correct and complete. Si vre ot Caimant �
/� Address (number and sfreef. city. state. ZIP code)
1 6�' 3 Du� s J 76 6S
ASSESSOR USE ONLY TAUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VAIUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately
surrounding residential improvemenis. (�) � �
Otherland (p)
Total land (line 7 plus line7� (3)
Dwelling (4)
Resideniial improvemenis
. Garage (5)
Other improvements (6)
Total improvements Qine 4 through line � (7)
Total value (line 3 p�s line � (g)
I hereby certify ihe abOVe is true. COrr2ct, and Signature of Assessor I Date signed
wmplete. •
�tying action � SgnaWre ot Auditor Date signed