Homestead_Harta��`� i CLAIM FOR HOMESTEAD PROPERTY TAX �q � PORN► �9 AS
;E�= CREDIT/STANDARD DEDUCTION �`�� 'iCiO
� Slate Form 5473 (R2/ �92) �
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INSTRUCTIONS: See ieve�se sidelor7iling instrucfions. �jjAY � J
� � _. - CERTIFICATION STATEMENT � j � f � �
T/;� //��'/ J�i vlu�'n (�
I(We�JRi»ES 4 �/L. . /JRENDA ��/. /`fF.ei cenif�tFf�tlo�fhe�7sidayofMarch,l9��
1(We) occupied as our principal place of residence the following described real property for which a Homesiead Property Tau Credit is hereby claimed: �
I�(We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable tor ihe property taxes on ihe property and thai owns ihe property or is buying under a contract.
. CONTRACTRECORDED �
If huying on contracC Fee Simple owner's name �
Recorder's oHice where comract is recorded Record number Page
� � PROPERTY DESCRIPTION
Counry Township Taxirg tlistrict (ciry, towq township)
G�r�so,.l Cc,��o,J
Pa¢el number legal description '
oo�_ ook�z-oo �!�� Se � 9 3_ �o >. so a�.
tl any ponion of the residential stmcture or Ihe IarM not ezceeding one (7) aae ihat immediatety surrounds Ihat structure is usetl to produce income, describe the use and portion
of the property utiiized to produce income.
�'�-/9- a9-a3aa- �o. e�>�-o�
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES � - �
Counry Township . Couniy Township
reby certity the above siatements are irue, correct and complete. Siqnamre of claiman�
�ress (numbeiandstreef, ciry, sfate, ZlPwde) �
2 a. /3ox 7� FT.i3,Z,,..,��f �7` �'d''
� 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 (line 7 plus line 2� (3)
Dwelling I (4) . .
Residential improvemenis
Garage (5)
Oiher improvemenis (6)
Total improvements (line 4 through lina � (7)
Total value Qine 3 p6s line 7� (g)
I hereby cehify the above is ime, Correct, and Signamre ot Assessor Date signetl �
complete.
Verifying action - Signature ot Auditar Date signed
STANDARD DEDUCTION ALLOWANCE
79_Pay19_
Lesser of tl2 Homestead
Valuation or $2,000 S
Signawre of Autliror Date signed