HomeMy WebLinkAboutHomestead_Lashbrook�E n�p
eE � CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
���� CREDIT/STANDARD DEDUCTION HCio
�i��� State Form 5�73 (R2 / 5-92)
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INSTRUCTIONS: See reverse side forliling instructions. - __
. CERTIFICATION�STATEMENT : � - �
�'e) ` _ (��1�,Kf�. certify that on the� 1 st day of March 1�
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I(We) occupied as o principal place of residence ihe following described real propeAy.for which a Homestead Property Tax Credlt�is here
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❑ I(We) owned ❑ Are buying under wntraci ,,'
❑ Have a beneticial interest in the entiry ihat is liable tor the property taxes on ihe pmperty and thai owns ihe property or is buying under a contract.
CONTRACTRECORDED -
II buying on contract, Fee Simple owner's name .
Rewrtler's oHice where comract is recorded Recorcl number Page
PROPERTY DESCRIPTION
Township I Taxing distriCi (Ciry. fown, town5hip)
Legal description
l.:l ' � 1.7(O CJO �
If any portion of ihe resitlential struaure or ihe land noi exceeding one (7) acre that immediately surr s that swaure is used [o produce income, descnhe the use and portion
of Ne property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
ounry Township Couniy Township
I hereby certify the above statements are true, correci and complete. Signamre of Caiman2
Address (num6erandsfree7. city, sfafe. ZlPCOde) �
p S
� ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE . -
Land not exceeding t(one) acre immediately
surrounding residential improvements. (�) � �
Otherland (p)
Total land (line 7 plus line 2� (3)
Dwelling (4) �
Resideniial improvements
Garage (5)
Other improvemems (6)
Total improvements (line 4 fhrough line � (7) I
Total value (line 3 pbs line 7) (g)
I hereby certify the above is Irue, correcL and Signamre of Assessor Date signed
(�plete.
Jying aaion - SignaWre of Auditor Date signed
STANDARD
19_Pay19_
Lesser ot 1/2 Homestead
Valuation or 52.000
of Auditor /\ � Date