HomeMy WebLinkAboutHomestead_Trible (3)e �; CLAIM FOR HOMESTEAD PROPERTY TAX
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CREDIT/STANDARD DEDUCTION -
� State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reveae side lor7iling instructions.
FORM NEAR
HC10
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� � _ CERTIFICATION STATEMENT . . -� MLFA!7 � -!JA'P
��e) � V,,� �_ _ � certify ihai�e�ts�i d�oi M��rc.�h,.�19
i �JJe) occupied as our principal place of residence e follo� 'n described real property tor which a Homestead Property Tax�r� r��1�15'��oy ciaiined:
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�(We) owned 0 Are buying under contrect . � .
Have a beneficiai interest in the entiry tNai is liable for the property taxes on ihe propeny and that owns ihe property or is buying under a contract.
� CONTRACTRECORDED . �
II buying on contraG, Fee Simple owner's name �
flecortler's office where crontract is recortled � Record number Page
County
' PROPERTY DESCRIPTION
Township Taxing distri�ciry, town,
Parcel number I Legal tlescription
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If any portion of ihe resitlential stmcwre or the land not ezceeding one (7) acre that immediatety surmunds that structure is usetl to produce income, describe the use and portion
ot Ne propeny utilized ro produce income.
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�- PROPERTY OWNED BY CLAIMANT INOTHER COUNTIES � '
County Township County Township
I hereby certify the above statemenis are true, correct and complete. Signamre of aim t �
Address (numberand stree( city, state, ZlPcode) � �
.300 /V. /�'iA�I✓ ST, %'r �i24�✓G�i � z 6 f�
ASSESSOR USE ONLV � TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
.VALUE VALUE VALUE . VALUE
Land not ezceeding 1(one) acre immediately � -
surrounding resideniial improvements. (�) � �
Other land - (p)
Total land (line 7 plus line 2� (3)
Dwelling (4) - '
Residential improvements
Garage �5� .
Other improvements (6)
Total improvemenis (line 4 through line � (7)
Total value (line 3 p�s line 7� (g)
I hereby certify ihe abOVe is �rue, CorreCt. and Signature of Assessor Date signed
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.yirg adion - Signa.ure of Auditor . Date signed
19_Pay79_
Lesser of 1/2 Homesiead
Valuation or 52.000
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STANDARD DEDUCTION ALLOWANCE
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