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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION '
State Fortn 5473 (R2 / S92)
FORM YEAR
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INSTRUCTIONS: �� �everse side /or filing instructions.
C TIF � N STATEMENT � �
I (We) � Q � th. 19_
I.(We) occupied as our principal place of residence the following described real property for which a H e��pQ�fJa(�3�Y(Ap,J11A�Rr y claimed:
❑ I(We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for Ihe property taxes on the property and ihat owns the property or is buying under a contract.
CONTRACTRECORDED � �
If buying on con[ract, Fee Simple owners name
Recordefs oHice where contract is recordeA Record number Page
PROPERTY DESCRIPT70N
Co�nry Township T ing di (ciry, wn, Immship) '
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Parcel number / Legal e p on � � �
-f/ - �d / cS
If arty portion of Ne resitlentiai siructure or the land not xceetlirg one (1) acre that immediatey surtourMS thai struciure is usetl to praduce income, describe Ne use and portion ot
ihe properry utiiized ro produce i�ome.
_ —O/_ GYJ—C�5���9 ���
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry 7ownship
Signat�mant �
.ereby certify the above statements are true, correct and complete. - G
Atl ress (number arrd streef, ury, sfate. ZIP code) .
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL �
VALUE VALUE VALUE VALUE
Land not ezceeding 1(one) acre immediately �� �
surrounding resideniial improvemen[s.
Otherland (2)
Total land (line 7 plus line 2) (3)
. Dwelling (4)
Residential improvemenis
Garage (5)
Other improvements (6)
Total improvemenis (line 4 through line 6J � (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, cortect, and Signature of Assesor Date signed
complete.
Veritying action - Signature of Audimr Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead c�
Valuation or 52.000
Signature of Auditor Date signed .