Homestead_Zehner (3)F-.
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�ifM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
Siate Form 5473 (R2l 5-92)
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INSTRUCTIONS: See �everse side for 7iling instiuctions.
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�e) u—Y �� rertify that on �he 1 st day ot March. 19_
�)�occupied as our principal place of residence Ihe following described real operty f which a Homestead Property Ta* Credit is hereby claimed:
.{We) owned ❑ Are buying under contract
Have a beneticial iNerest in ihe en;iry that is liable for the propeny taxes on the property and that owns ihe property or is buying under a contract.
CONTRACTqECORDED
II buying on contracl. Fee Simple owner's name
Recorder's ottice where contract is recortled - Record number Page
PROPERTY DESCRIPTION
Counry � Township
Parcel nu�mb^er Legal descnption
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L' any por,ion ol the residemial stmc;ure or ihe lantl not erceeoing one ( t 1 acre that immetliateh� surrounds that stmcmre is used ro produce income. descri6e the use and ponion _
ot tne pmperty utilizetl to protluce income.
County
Address
_�7-/3- �/J-CX.d.C]G
PROPERTY OWNED BY CLAIMANT IN OTMER COUNTIES
the above statements are tme. correct and complete.
� and street. uty. state. ZIP cooe) ,�,.� ,/ ,
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately I' , I I f
surrountling residential improvements. �
Otherland (p)
Total land (line 7 plus line 2� I(3) (
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Dwelling (4)
Residential improvements
Garage (5) I (
Other improvemenis (6)
Total improvements (line a rhrough line � I(� � I I ,
Tmal value (line 3 pbs line 7� (g) .
I hereby certify the above is �rue. correC�. and Signa;ure of Assessor Dare sfgned
comp�ete.
�Verif�ng actio� - Sfgna;ure of Autlitor I Daie signed
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�9_Pay19_
Lesser ot 1/2 Homestead
Valuation or 52.000
STANDARD DEDUCTION ALLOWANCE
5
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