Homestead_Schmits (11)����'? a CLAIM FOR HOMESTEAD PROPERTY TAX
�a�': CREDIT/STANDARD DEDUCTION
.�.�q .` J State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See �everse side (or liling inslruc(ions.
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certify. that on the 1 si day of March, 79_
�) occupied as our principal place of residence the follovrin9 described reat�property for which a�estead Property Ta�c Credit is hereby claimed:
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LJ I(We) owned ❑ Are buying under coniract , , �
❑ Have a beneficial interest in the entiry ihai is liable for the property tazes on ihe property and ihat owns ihe property or is buying.under a contract.
� � � ' CONTRACT RECORDED - ' � � - �, � � �� �
It buying om m�trect, Pee Simple owner's name � .
Recorder's oftice where contraci is recorded Record number Page.
� - " PROPERTY DESCPIPTION - � � �- �
y �. ' Township ' Tari dislrict (pry. town, township) .
number Legal scri tion
'> -� �� 5 Sw x� a- � 1.��,
ponion of ihe residential siructure or the lantl not exceeding one (7) aae Ihat immediately surrounds that structure is used to produce income, describe the use and portion
properry utilized to produce inmme.
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PROPERTV OWNED BY CLAIMAM IN OTHER COUNTIES - '� -
Counry Township Counry Township
�eby certity the above statements are true, correci and complete. namre f claiman[ .
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ress Inumberandstree(. dry state, ZlPCOde)
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD .� NON-RESIDENTtAL
, .VALUE VALUE �VALUE VAWE
Land not exceeding 1(one) acre immediately �
surroundingresideniialimprovemenis. (�) ��
Otherland . (2)
Total land (line 7 plus line Z� (3�
Dwelling (4) � -
Residential improvements
Garage (g) _
Other improvemems (6) - . �
Total impmvements Qine a through line � �7) I
Total value (line 3 pLs line 7� .(g)
I hereby certity Ihe above is Irue, CorreCt. and Si9namre of Assessor Date signetl
complete.
vanfyirg action - Sgnature of Auditor Date signed
79_Pay79_
Lesser of 1l2 Homestead
Valuation or 52.000 �
STANDARD DEDUCTION ALLOWANCE
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SignaWre of Autlitor I Date sgned - -�
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