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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION .
Sfate Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side for (iling instructions.
STATEMENT
FORM
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YEAR
I(We) - V 1 / ' e' f rch, 19_
I(We) occupied as our principal place of residence the follo ng des ' ed real property for which a �t@8L1?tS�]t�AT"a`k 6i�8hT9flereby claimed:
❑ I(We) owned ❑ Are buying under coniract
❑ Have a beneficial interest in the entity that is liable for Me property taues on the property and thai owns the property or is buying under a contract.
on
name
contractis recortled
CONTRACTRECORDED
PROPERTY DESCRIPTION
tOwnship)
�J I 1- W 5 I J'vU I �/ V I U( [ o`
It any portion of the residenfial sWCture or the land not exceeding one (1 � acre that immediatey sunounds that swcture
ihe pmperty uulized to protluce income.
PROPERTY OWNED BY CLAIMANT IN OTHER
' �� ry I7ownship
'�/
T
� ieby certify the above statements are true, correct and complete.
,,
ASSESSOR USE ONLY
Land noi exceeding 1(one) acre immediatety
sunounding resideniial improvemen4s.
Otherland �
Total land (line 1 plus line 2)
Dwelling
Residential improvements
Garage
Other improvements
Total improvements (line 4 through line 6J
Total value (line 3 plus line 7)
I hereby certify the above is true, correci, and
complete.
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I
ot Auditor
19_ Pay 19 _
Lesser of 7/2 Homestead
Valuation or S2,000
TRUE TAX
VALUE
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l2)
(3)
(4)
(5)
(6)
I�)
�8)
ta
ASSESSED I HOMESTEAD
VALUE VALUE
STANDARD DEDUCTION AILOWANCE
5
number
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NON-RESIDENTIAL
VALUE
signetl
Date si9ne0
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