Homestead_Moodye`�� "� f CLAIM FOR HOMESTEAD PROPERTY TAX PoRM YEAR
�;a�' CREDIT/STANDARD DEDUCTION HC�o
State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See �everse side tor liling instructions.
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I(We) �' V\�61�i � cenify that on ihe 7st day of March, 79
�) occupied as our principal place of residence the following described r property for which�a Homestead Pr�rty Tau Cred�t is �re%by Gai ed:
i(We) owned ❑ Are buying under comract ),✓ ��-,i'i.-}-��
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❑ Have a beneficial interest in ihe eniiry ihat is liable for the property taxes on ihe property and thai owns the property or is buyin9 under a con[raci.
" � - - CONTRACT RECORDED . - " - - - "
tl buying on contract, Fee Simple owner's name �
Recorder's ottice where contract is recorded Record numher Page
" � PROPERTY DESCRIPTION �
Township Tazirg dstrict (City, to�n, town5hip)
Parceinumber (jV/'-(�l_`/3��j'_ legaldescription�
� vs-ooa 3�-� -f- S S F a� - 3- l� �_ a5 l�C
It any ponion of ihe residential svucNre or the land not e+ceeding one (1) aae that immediatey surtounds that siructure is usetl ro protluce income, descnhe Ne use antl portion
ot Ihe pwperry utiiized to produce income. �
_ /� a9-SLao - �� 93�- aas
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTIE& � �
County Tawnship Counry Township
�eby certity ihe above slatemenis are Irue, correcl and complete. Signature ot ciaimam
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Adtlress (numbei and sveet ciry. state, ZIP code)
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
� VALUE VALUE. VALUE VAWE �
Land not exceeding t(one) acre immediately
surmunding residential improvements. (�) "
Otherland (2)
Total land Qine 1 plus line � (3)
Dwellin9 (4)
Resideniial improvements
Garage (5) -
Oiher improvemenis (6)
Total improvemenis (line 4 Ihiough line � (7)
Total value (line 3 p�s line 7� (g)
I hereby Cehify [he above is irue, CArreCt, and Signature of Assessor Date signed
complete.
Ve�nfying action - Signature of Audiror Date signed
19_Pay19_
Lesser of 7/2 Homesiead
va�uation or 52,000
STANDARD DEDUCTION�
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