Homestead_Rexing (6)Y�� CLAIM FOR HOMESTEAD PROPERTY TAX
i
�;; CREDIT/STANDARD DEDUCTfON
,�, • Siate Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side !or /iling instructions.
FORM YEAR
HC10 +
���We) certp�wy t n e� �1 snt day of March, 19_
'e) occupied as our principal place of residence the (ollowing described eal operty tor which a Homeste88 �p�a1JJ�it is hereby daimed:
❑ 1(We) owned ❑ Are buyin9 under contract
� � �:
❑ Have a beneficial inierest in the entiry that is liable for the property taues on the property and th __ _ , � 6 '}�i.,_(i� a contract.
_� . . . ; . - CONTRACTRECORDED � . ,. . . `-- • ,�::,. � .'
. - _ . .. . . .... . _.. . .:.... _
If buyirg on contraa, Fee Simple owner's name
Recorder's ottice where comraa is recordeC Recortl number Page
� PROPERTYDESCRIPTION ' � `. �$'.. .. :"�'�....- V .
Counry Township Tacinq district (ary. fown. township)
gJiFeJ„pum r � _ Legal descnption
1� lJ
If any portion of the residential stmcture or the land not exceeding one (1) aae [hat immediatety surrounds that swc[ure is used ro produce income, descdbe Ne use and portian
oi Ne property utilizetl to produce income.
C/IC0' / / � O —Q7U(J' (iC-
PROPERTY OWNEO
Township
certiry ihe above siatements are ime, wrrect and complete.
bvr.rberarMSUeeLdN.state,ZlPcode) � � i „ rA-
— Q��/
Counry
. ASSESSOR USE ONLY TRUE TAX ASSESSED NOMESTEAD - NON-RESIDFNTIAL�: '
� VALUE VALUE VALUE VALUE �
Land noi exceedinq 7(one) acre immediately � -- - -�
surtounding residential improvements. (�) �- "�
Otherland (2) ' - _
Total land (line 1 plus line Z� (g)
\ Dwelling (a) � . � . e -� .
Residential improvemenis . . I
Garage (5) ' �
Other improvements (6) �
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line 7� (g)
I hereby certify the above is true, correct. and Sgnamre ol Assessor Dare signed
complete.
�tyirg action - Sgnature of Audibr Date signed
19_Pay19_
Lesser of tl2 Homestead
Valuation or 52.000
5
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Sgnature o� Autlitor _--��� , \ � I "a`y'fi'� � (%` (:, I
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