Homestead_Keil� CLAIM FOR HOMESTEAD PROPERTY TAX
° CREDIT/STANDARD DEDUCTION
t / State Fwm 5473 (R614-03)
' Prescribed by Na Department o( Local Govemment Finance I /
INSTRUCTIONSi See ieverse side for filing instructions. K�
Il
FORM YEAR
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I(We) `Y certify that on the 1st day oLMarch, 20_
I(VJe) occupied as our principal place of residence the following described real property for which a Homestead Property T�c Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under contreci
1 Have a benafidal interest in the entiry that is liable for ihe property taxes on the property and ihat owns the property or is buying under a conVaa.
If bvying on contraq, Fae Simple ownefs nama
Recordefs office where contract is recorded
Counry
Percel number
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IdNa��o
P�PartY
Rewrd number
Pega
Township Tming dlstrict (ciry, town, township)
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Lepal description Is Ne property in question:
— — — R al property ❑ Mabile Home (1.Q 61J�n
:tiucWre or Me land nol excaedinp one (7 ) afxa that immediatey wnwnds Nat s ctura is used to produce income, describe Na use and Dortion
caincome. �� �Q Q�
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.-�::�:c.2_ �•�.Ij`, -t§Fa�irpROP.ERTY.OWNED�BY:CLAIM/1NT;IN''OTNER'COUNTIESa.�..=:h:-��^�gFr„?' -��"'-?= �>-���t,
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Counry n 7wvnship County To.vnship
I hereby certify the above statemenLS are We, cortect and complete. Signeture o1 cleiman�
dress (number end sveet, ciry, state, ZIP code)
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����F'��ASSESSOR USEIONLY�: �� 3,� �iTRUE TQX� s ASSESSED V/1LUE � HOMESTEADx �.�� NON�RESIDENTL4L +�`
'rv5�!a+.�+.��.a�'�Lx��-�.+.,wJ-`s_�i.3}�,.c i,�'i4 ;VALUE,�..s �;AT:100%OFTTV �> _",VALUE �:.>rw-�?��VALU.Ezrx..��;«.�.>
Landnotexceedingt(one)acreimmediatey (�� � � - ' ,��. ;�-�, l;Y `}�'� �%��� =
surtounding residential improvements. 3« ��,,, � ,�� r,;
OtherlarM �y� '��•: �'
TKaI land (Ifne 1 plus line 2) �g)
Dwellin9 (4) - } .. �:l + � ti �� .' �' �;�.
ResidenlialimprovemenLSOrMnualty . .3.� � „_��, as
Assessed Mobile / Manufadured Hame j� � -" n 5 ,� .', k�'
Gara9e (5) � y'�?:: • -' <
'� 4.c. �
O�qerimprovements (6) .." _
Tatal Improvements (line 4 throtgh lirre 6) (7� .
Ta[al value (line 3 phs line n (8)
I hereby certiy the above is We, corted, and � Signawre orASSessw Dau sipned
complate. � .
Verilymg action - Signatura ofPUditw Data sipned
`���';?� !. °i ? �-�3?,. ° 3'� � ,t�'=� .d�-.`'w�STANDARD!DEDUCTION'ALLOWANCE� : ,�.� .
20_Pay20_
Lesser of tf2 Hwnestead
Valuation or 535,000 S
SlpnaNre af luiditw ' Date signed