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ea ; CLAIM-FOR HOMESTEAD PROPERTY TAX .
}��': CREDIT/STANDARD DEDUCTION _
`.,.�,;;� StateForm5473(R2/5-92)
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INSTRUCTIONS: See reverse side /or tiling instruc(ions. �
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e) _ K � certify_that on ihe isi day of March, 19
.,.Je) occupied as our pnnq p I place of residence the f lowing descri realpropeny for which a Homestead Property Tax Credit is hereby claimed:
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❑ I(We) owned �J Are buying under con�ract �
❑ Have a beneticial interest in ihe entity ihat is liable for ihe property taxes on ihe property and ihat owns ihe property or is buying under.a contract.
� CONTRACTRECORDED . �
If buying on contracL Fee Simple owner's name , . .
Fecorder's ottice where comract is recorded Recortl number Page
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m ot
Tovmship
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idential simaure or ihe land noi
ro O�oduce income.
PROPERTY DESCRIPTION
aCre tha�
� -/5' �SL /��- �oo. �� =Ga�'
lown.
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swcWre is used to produce iricome, describe ihe use and ponion
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
p Counry
I hereby certify ihe above statements are true, correci and complete.
Atltlress number and streef, dty. stafe. ZIP code)
X�'� 2 d� o� /o i fl 7�.� �i�.�
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ASSESSOR USE ONLY - TRUE TAR � ASSESSED HOMESTEAD �NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediatety
surrounding residential improvements. (�) -
Otherland (2) �
Total land (line 1 plus line 2� (3)
Dwelling (4)
Resideniial improvements '
Garage (g) � �
Oiher improvements (6) �
Total improvemenis (line 4 through line � (7)
Total value Qine 3 pbs line 7� (g)
I hereby certity the above is true, correci, and signamre of nssessor oa�e signed
molete.
�ng action - Signature oi Autlibr Date signed
19_Pay19_
Lesser of 7/2 Homesiead
Valuation or 52.000
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ALLOWANCE