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Homestead_Loehr�E RIR � ,
e� ; CLAIM FOR HOMESTEAD PROPERTY TAX "
l��E CREDIT/STANDARD DEDUCTION
:,�;,;�� State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See �eveise side foi liling ins[ructions.
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IIWe)��y o,S1� �� `�S�L.�--O-�� -�2i� J . certity.t thels davb�'6Aarc��
) occ ied as our principal plac f residence the following described real property for which a Homesiead Property Taz Credit�hereby c ai
. � we ow�ed . AUDITOR
( ) ❑ Are buying under contract . .
Have a beneticial inieresi in the entity that is liable for ihe property taxes on the property and that owns the property or is buying under a contracL .
� � ' '� � � � CON7RACTRECORDED ' � ° -
I( buying om m�tract, Fee Simple owner's name . . . �
Remrdets oHiCe where contract is recortled Record number Page
'� PROPERTY DESCRIPTION � � � -
Counry , Township � ' � Taxirg district (ciry, favq rownship) . .. ' . '
Parcel number . Legal description . _ ,
b - � `i-00
If any portion ot ihe residemial strupure or the lantl not exceeding one (1) acre ihat immediatety surrounds that simaure is used to produce income. describe the use antl portion
oi the pmperty u:ilized to protluce income. -
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PROPERTY OWNED BY CLAIMANT IN OTNEH COUNTIES ��
Caunty Township Counry Township
�eby certify ihe above statements are true, correct and complete. Signafure of claimam `
Address (number and stree(. ary, sfate, Z/P cotle)
fL 2! C-x� 3 2 —o,� B2A�1/ `i7� ��
ASSESSOR USE ONLY � TRUE TAX ASSESSED HOMESTEAD NON-RESIDEN'fIAL.
VALUE� VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately
surtounding residential impmvements. ��) ���
Oiherland (p) .
Total land (line 7 plus line 2� (3) �
Dwelling (4)
Residential improvemenis . . r
Garage (g) �
Other improvements (6) -
Totai improvements (line 4 lhrough line � (7) �
Total value (line 3 pUs line � . (g)
I hereby Certi}y the above i5 We, corred, and Signamre of Assessor Da;= sgned
complete.
y�ing action - SgnaNre of Autlitor Date siqnetl
19_Pay19_
lesser of 1/2 Homestead
Valuation or 52,000 �
Sgnature of
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DEDUCTION ALIOWANCE
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signed
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