Homestead_Smith (6)e��''R q CLAIM FOR HOMESTEAD PROPERTY TAX ' " � FoRM vEAa
i��= CREDIT/STl�NDARD DEDUCTION . HC�o �
�:�� State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side /or /iling insfiuctions.
I1We) V WQ' 7 . certify�that onitie`fsiHa�of'Alarch, 19
�) occupied as our principal place of resid e the following described real property for wtiich a Homestead Pr erty Tau Credit i ereby d im �
❑ 1(We) owned ❑ Are 6uying under wntract � , �
❑ Have a beneticial interest in ihe entity ihai is liable for the property taxes on ihe property and that owns the �{p6 QfiFt TiMdtH���a .
- • - . CONTRACTRECORDED - � � ' � �
Ii buying on contraci. Fee Simple owner's name • . � ' � . , � � �
Recorder's oHice where contrect is recordetl Record number Page
Caunry
Township
- PROPEflTY DESCRIPTION �
town,
PQ �Om�r� I � � � IW I Legal tlescnption I/�� , ` , 1. , ` /,'` U — � / I � ` � �
�iJ vl.% � v� �
If any portion of the residential structure or the land not exceeding one (1) aae that immediatety surmunds that struc[ure is used to produce income, describe Ihe use aM
of ihe property utilized to produce income. ,
e
PROPERTY OWNED BV CIAIMANT IN OTHEF COUNTIES
Coun�y Township COUnry To•+m5hip
�eby certify the above statements are true, correct and complete. Sig amr oi claimam
Atltlress (number and s1reeC ciry, stare, ZIP mde)
'� 219 '1 �15
ASSESSOR USE ONLY �� TRUE TAX �ASSESSED HOMESTEAD NON-RESIDENTIAL
.VALUE VALUE- VALUE VALUE .
Land noi exceeding 1(one) acre immediately
surrounding residential improvements. (�) '
Other land (p�
7otal land (line 7 plus line 2� (3)
Dwelling (4) � �
Residemial improvements , . .
Garage (g) -
Other improvemenis (6) .
Total improvements (line 4 through line � (7)
Total value (line 3 p6s line 7� (g) .
I hereby Certify the above is �rue, correCt, and Signamre of Assessor Date signed
complete.
V�ying action - Sgnamre of Auditor Dare signea
� � � � STANDARD DEDUCTION ALIOWANCE
79_Pay79_ . .
Lesser of 1/2 Homestead
Valuation or 52.000
S
Sgna[ure of Audl;or l \ Date s' etl
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