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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fo�m 5073 (R2 / 5-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC70
YEAR
CERTIFICATION STATEMENT
1(We) � certify that o 1s a f Mar , 9
I(We) occupied as our principal place of residence the following ifescribed real properry for which a Homestead Property Cr i b .
❑ I(We) owned ❑ Are buying under contract � � D E C O 1 ZOOO
❑ Have a beneficial interest in the entiry that is liable for the property taxes on the property and that owns the property or is buying under a co tract.
. CONTRACTRECORDED
If buying on Contratt, Fee S'unpie or.nefs name �
flecorders otfxe where contract is recorded , RecorC number Page
PROPERTY DESCRIPTION
Couniy � Township Tacing tlisirict (ciry, own, tmmship) �
z, s-� .✓ o �✓ 7� .
Parcel n ber - Legal tlesc ption '
pp� 0�999-0 0
If any portion of the residentiai struc[ure or the land rrot exceeding one (7) acre ihat immediatey surtounds that sWCture is used to protluce income, describe ihe uu and portion ol
Ne properry uGlized ro protluce incame. : � � ' � . . . .
�- 9-G�'- oQ -�/ 99- ���'
PROPERTY OWNED BY CIAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
Si Nre o la ni �
•iereby certify the above statements are true, co�rect and complete. �
AEGress mber and 5t2et, ciry, state, ZlP wde) '
� % `f'� �o �' � �r� ti h � , �%6�
ASSESSOR USE ONLY TRUE TAX . ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (��
surrounding residential improvements.
Otherland -� (2)
Total land pine 7 plus line 2) (3)
Dwelling (4) .
Residential improvements
Garage (5) � _
Other improvements (6) "
Total improvemenis (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify Ihe above is true, COrreCt, and Signature of Assesor Date signetl
complete.
Verifyi�g action - Signature oi Auditor Date signetl
STANDARD DEDUCTON ALLOWANCE
— 19_ Pay 19 _
L er of 1/2 Homestead $
Valu ' or $2,000
SignaNre of Autlitor Date signetl
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