HomeMy WebLinkAboutHomestead_Barnett�,. .,,,�
a�� ; CLAIM FOR HOMESTEAD PROPERTY TAX
_ �. CREDIT/STANDARD DEDUCTION
: �'� State Form 5473 (R2 / 5-92) �
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INSTRUCTIONS: See reveise side lor filing instructions.
FORM YEAR
HC10
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.f � �� F
,�
1_�) ���_� i y�a l..�.+���-cx-- ify.thai on t e t��ay of Marctt�l9_
) occupi s our principal place ot residence ihe following described real property for which a Hom ead Pro �T� ii,jg,tiereby�daimed:
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I(We) owned ❑ Are buying under contrect ?,�,�,� i.:��! CC'j'r?� � ��" ��^ �
❑ Have a beneficial interesi in ihe eniity ihai 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 . _ � � .
Recordefs oftice where comract is recortled Record number Page
Couniy
� � - PROPERTY DESCRIP'fION
Township ' � Ta�cing distria (ciry, fown, rownship)
Parcel number Legal description
o t�- Doi o4 -o o Pc�.a (�� 4 P� caS� l3-3 -1 I o�A�
I1 any portion of the resitlential structure or Ne land not exceetling one (7) acre thai immetliatey surmunds that SWCNre is usetl �o produce inmme, tlescribe t�e use antl portion
ot the property uulized ro protluce income.
� PROPERTY OWNED BY CLAIMANT IN OTHEfl COUNTIES � -
Caunry Township County Township
eby certify the above statements are true, correct and complete. Sgn . cl -mam� �
Atldress�numberan�tls��e� state,ZlPOOde)
/P/ �"t'o cK �f �,QA�/cN /�✓ '!7G �F8
� ASSESSOR USE ONLY � TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
, VALUE VALUE - VALUE VAWE
Land not ezceeding 1(one) acre immediately
surrounding residential improvements. (�) '
Oiherland (p)
Total land (line 1 plus line Z� (3�
Dwelling (4) ' -
Residential improvements
Garage (5)
Other improvemenis (6) � �
Total improvements (line 4 thiough line � (7)
7otal value Qine 3 pbs line 7� (g) I
I hereby Certify Ihe above is lrue, CorreCt, and Signawre of Assessor Date signetl
complete. �
�rying action - Signature ot Auditor Date signed
STANDARD
19_Pay19_
Lesser of 7/2 Homestead
Valuation or 52.000
6'
Sgnawre of Autli:or Dare sign
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