Homestead_Mossberger (3)�,^.R . .
e�/ -' °g CLAIM FOR HOMESTEAD PROPERTY TAX
z��'E CREDIT/STANDARD DEDUCTION
,�;,��� State Form 5473 (F2 / 5-92)
uu
INSTRUCTIONS: See reverse side lor filing instructrons.
FORM YEAR_
H�,o , 4�s
N � �!°��
.�a, ._ . �[
��) �• �' ��n- • �`✓ . certif ihat on the 7st day of March, 79 9 T
z) occupied as our principal place of residence ihe tollowing described real property for �hich,�or�ste� Tax Credii is hereby daimed:
�N+"� ITOR
� I(We) owned ❑ Are buying under coniract AU�
❑ Have a beneficial interest in ihe entity ihat is liable for Ihe property taxes on the property and thai owns ihe property or is buying under,a contract.
- CONTRACTRECORDED � � �
It buyirg on contract, Fee Simple owner's name - _ �
Recorder's oflite where contract is recorded Record number Paqe
PROPERTY DESCRIPTION -
Coun�� Townsn{_ o � Tazing district (ciry, town, fownship) .
(��/t-G�7ti
Parcel num6er Legal descrip,nqn
pp�-oda73-oo /�,t .5�,z SE Z9-3-�� /.So�Lc.
It any ponion of Ne residential swaure or ihe land not exceeding one (1) aae ihat immediatey surmunds that structure is used to produce income, describe Ne use and portion
of ihe property utilized to produce income.
Counry
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Tawnship Counry
certify the above statements are true, correct and complete.
Address (number and stBet. pry. srate.
Uaimant
i
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDEN'fIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately
surrounding residen�ial improvements. (�)
Oiher land (p) �
Tmal land (line 7 plus line 2� (3)
Dwelling (4)
Residential improvemenis
Garage (g)
Oiher improvements (6)
Total improvements (line 4 through lina � (7)
7otal value (line 3 p6s line � (g� I
I hereby Certify the above is irue, GorreCt, and Sgnamre of Assessor Dare signed
complete.
-•ing aaion - Sgna;ure ol Auditor Date signed
79_Payt9_
Lesser of 1/2 Homestead
Valuation or 52,000
E
Sgnature of Autlitor Date signetl
� � .�l'. ��r�I's S- � - `�'�
_ i �