Homestead_Burger�j,�E �
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Fortn 5473 (R2 / S92) .
FORM
HC70
YEAR
�i
INSTRUCTIONS: See reverse side �orliling ins(ructions. .
CERTIFICATION STATEMENT
I(VJe) � C./` certify th��h�1 � d�M�March, 19_
I(We) occupied as our principal place of residence the tollowin described real property for which a Homestead Properry Tax Cred' hereb lai d:
❑ I(We) owned ❑ Are buying under wntrad
❑ Have a beneficial interest in the entity that is liable for the property taxes on ihe property and ihat owns the r �rj�tl9TQ�tr ct.
GIB ON
CONTRACT RECORDED '
It buying on convacl, Fee Simple owners name
Recortler's otfice where coniract is recorded Record number Page
PROPERTY DESCRIPTION
Counry �/ n TOwnship /�� O� Tadng di52ri/q /(p'ty�, /town, tow/n5h%/nI7 �
� J S !iL � (/I N i � N / w
oOnumber O �� / Legal description
T �
If any portion ot ihe residemial strucNre or the lantl not exceeding one (1) acre ihat immetliatey surmunCS Nai strunure is usetl ro protluce income, describe ihe use and ponion of
ihe property utliized ro proEuce inrnme.
�'- 9� -�3a� - �a. 0 9��s
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
SignaWre of imant ��
ereby certify the above statements are true, correct and complete. �
Adtlress (nomber and sbeef. ciry, stafe, ZIP crode/
� # 6o J �
ASSESSOR USE ONLY .?�UETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately �� �
surrounding residential improvemenis.
Otherland - (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residential improvemenis
Garage (5)
Olher improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (B)
I hereby certify the above is true, correCt, and Signature of Assesor Date signed
complete.
Verifying action - Signature ot Auditor Date signetl
�.� STANDARD DEDUCTION ALLOWANCE
7 Pay 19 _
Le erot 1/2 Homestead c�
a' o $2,000 .
SignaWre of Autlitor Date signed —\
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