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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Fortn 5473 (R2 / S92)
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/ CERTIFICATION STATEMENT
� J ,�(� �� � N cour:7Y AI 'p� �
I(We) � , K`Sd_A-.�-� � certify that on the 1st day of Marc�i, i9_
I(We) occupied as our principal place of residen e e followi described real property for which a Homestead Property Tax Credit is hereby claimed:
We) owned ❑ Are buying under contract � -'
Have a beneficial interest in the entliy that is liable for the property taxes on the property and that owns the property or is buying under a coniract.
CONTRACT RECORDED -
If buying on conVact, Fee Simple ownefs name ,.
Recordefs oKce where conVact is recortled Record number Page
PROPERTY DESCRIPTION
Counry Township � Tarzi�g distrid (ciry, fown, township)
Parcel number Legal descnp6on
o� - C�ID(�'l-o�
If any poNOn of the resitlential structure or the land frot exceetling one (1) acre thai immediatey surtounds that sWCture is used to produce income, tlescribe the uu and ponion of
ihe property uhLzetl ro produce income.
�-/9or'- �a-����7- oas
_ PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Caunry Tovmship
Signature f tlaimant
ereby certify the above statements are true, cortect and complete. �
Address (number an0 streeL ciry, state, ZIP crode) �
r2� D �� R���� �OJ b�fg'
ASSESSOR USE ONLY � TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE� VALUE VALUE VALUE
Land not ezceeding 1(one) acre immediately �� �
surtounding residential improvements.
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwellin9 (4)
Residential improvements
Garage (5)
Other impravements (6)
Totai improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certi(y the above is true, conect, and Signature of Assewr Date signed
complete.
Verifying acuon - Signature of AuUitor Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
Valuation or $2,000
Signature of Autlitor , Date signedQ 7'�
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