Homestead_Ricee�-'"�°, CLAIM FOR HOMESTEAD PROPERTY TAX .
x;E�;; CREDIT/STANDARD DEDUCTION '
.�,,; • Stale Form 5473 (R2 / 5-92)
�u.
INSTRUCTIONS: See reve�se side lor filing instructions.
EAR
g-'�� � _
DEC p 1 1997
I(We)__��'J�� �'¢"L-Q.J�.Pi��y�.�.+CAi certify�l�at�d'mtAe�1's[:dayof�March:'7�7p �
�_) occupied as our.principal place of residence the follovring described real pmperty for which a Homestead Property 7arz Credii is hereby daimed:
LJ I(We) owned ❑ Are buying under coniract � � , �
❑ Have a beneficial interest in ihe entity ihat is liable for the property taxes on the property and ihat owns the property or is buying under a contract.
� CONTflACTRECORDED . - ' -- �
It buying on wntract, Fee Simple owner's name - .. � � .
Recordef5 oflice where Contrad is reCOrded Retord number Page
Counry
It any
of the
7ownsNp
Legal tlescription ,
0�11JL1��
of ihe residential stmcNre or ihe land not exceeding
y utilized lo protlute inCOme.
PROPERTY DESCRIPTION �
� � Taxing districi (ciry, town, townstip)�:�
���. i a-3 - � � .�y �9�
(7) acre Ihat immediately surrounds Ihat siructure is used fo produce income, describe �he use afW portion
� PROPERTY OWNED BY CLAIMAM IN OTHER COUNTIES -
Counry Township COUnty Township
�eby cenify the above siatements are true, correct and complete. Signamre o� claima
Address (number and sbeet, pry, sfate, ZIP code) � Q� ( Q�
� V�b�{
ASSESSOR USE ONLV TR TAX ASSESSED NOMESTEAD NON-RESIDENTIAL.
VALUE VALUE VALUE � VALUE
Land noi exceeding 1(one) acre immediately
surrounding residential impmvements. (�) '
Otherland (p)
Total land Qine 7 plus line 2� (3) � .
Dwelling (4) � .
Residential improvements � , _
, Garage (5)
Other improvements (6)
Total improvements (line 4 thiough line � (7)
Total value (line 3 p�s line � (g)
I hereby Certify lhe above i5 ime. correCt, and Signature ol Assessor Date signed
complete.
Verityirg action - Signature of Audimr Dare signetl