Homestead_Goodman;�
rt� t CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
s: . CREDIT/STANDARD DEDUCTION HCiO _
,��` ' State Fortn 5473 (R2 / 5-92) 17 ;� t:f i•.� �n _%_
INSTRUCTIONS: See �everse side for /iling instrucfions. �����n� �
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.. . � . . ' .;.. .. . . '.. CERTIFlCATION STATEAAENT ;.s ` � , . ", y ,�. ` " -
I(We) C. �����%ZQ� � � � ceniry th i�on the•1st day of March, 19 �
/n ti._ .. /C // i �
I(We) occu as our principal place of residence the following described real property for which a Homesteatl Pro"perty�Tau Qredi�5shereby d� ed:
� I(We) owned ❑ Are buying under contrect
r" '.'J�'T��
�,� Have a beneficial interest in ihe entity that is liable for the property taxes on the property and Ihat owns the property or is buying under a coNraa.
. - ..� i, �_ : �. CONTRACT RECORDED ..; . i. .. - - t';,�.�. - � � :-. � ;•.' ° .
If Wying on contract, Fee Simple owner's name
RecoNer's oHice where contraa is rewrded Record number Page
Parcel number
If any portiOn o( ihe residential Stn
of ihe properry utilized ro produce
' � � PROPERTY DESCRIPTION� - _'�"'
Township Ta�ci(g dis �ct (dry, town, fownship)
Legal deuription^
� � J
or Ihe IarM nol ezceeding one (1) that immediat �r sunountls Nat sVUC[ure is used to
- �!f '�7- /D/' CJ�/ /1 �T - D�.J
/ (o
�. describe the use and ponion
� PROPEHTY OWNED BY CLAIMAM IN OTHER COUNTIES -
Counry Township Counry Township
I hereby certiry the above statements are true, correct and complete. Sg re of ciaimam
ress (number arrd streeL ciry. sfare, ZIP codel
�� ASSE§SOH USE ONLY ��. � TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL` ,
. . � � - VALUE VALUE VALUE VALUE �
Land not exceeding 1(one) acre immediately .
surmunding residential improvements. (�) � � �
Otherland (2) � ��
7otai land (line 7 plus line Z� (3)
Dwelling (4) � � .
Residential improvements .
Garage (5)
Other improvements (6) -
Total improvemenis (line 4 lhrough line � (7) �
Total value (line 3 p�s line 7� (g)
I hereby Certify Ihe above is true, correCt. and Signamre of Assessor Da;e signed
compiete.
Venyirg aaion - Signature of Auditor Date signetl
� � � - � � � � _ � - -. STANDARD DEDUCTtON ALLOWANCE" , � �.-i�;�.' '� . , �
79_Pay79_
Lesser of 1/2 Homestead
Valuation or 82,000 �
SgnaNre ditor � Date signeC