Homestead_Nurrenbern�` °"� YEAR
;����� CLAIM FOR HOMESTEAD PROPERTY TAX FORM
ar CREDIT/STANDARD DEDUCTION HCtO
,'��' Sute Fortn 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side Ior7iling inshucfions.
. . . . ,-`•- . � �. :. � -CERTIFlCATION 5TATEM HT;� � - - .� .
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I (We) % G �/ . � �`-/` C.�v � 1�-.. .. . . certi a on�tNe 7st'd�,,o
I(We) occupied as our principal place of residence the following described real property for which a Homestea�o � Ta�,ar��
I(We) owned ❑ Are buying under contraci (�
I� Have a beneficial interest in the entiry ihat is liable for the property taues on ihe property and thai owns the pran§�tyc�piQbu�,�99
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'� . ...�CONTRACTRECORDED_�� .. '_ U't... �yii1��'k'Z?�c1+
If buying on contraa, Fee Simple owner's name ��16SC" `- � �
'. Recorder's ottice where contract is remrded Record number
� � - PROPERTY DESCRIP'T10N � � �
Counry � Townshi Tazing district (cdy; t n, ship) �
, s�-, �c// d .✓ �%i o ,./ l ,dc� -
Parcel number Legal descnption
d�%- O� �-%`'� U
1
i. 7 9
� daimed:
:� u..��
Page
If any ponion ot ihe resbennai s[ruaure or the land not ezceeding one (7) aae t�at immediatety wrmunds that siruciure is usetl to produce ixome, describe Ihe use and portion
of ihe properry ulilized to produce income.
_ /9-a�'-3vo-o�a a�'��
.. �� � ASSESSOR USE ONLY . TRUE TAX ASSESSED MOMESTEAD .� NON-RES�DENTIAL`-�' ,
- . � . VAWE VALUE VALUE VALUE -
Land not exceeding 7(one) acre immediately �
surrounding residential improvements. (�) - -
Other land (p) � � - �
Total land (line 7 plus line Z� (3)
Dwelling (a) � � . � � �
Residential improvements . �
Garage (5) � �
Other improvements (6) �
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line � (g)
I hereby Certify Ihe above i5 tme, correci, and Sgnamre of Assessor Date signed
complete.
Verityirg anion - Sgnature of Autlitor Date signed