Homestead_Sollman (6)y-_� t CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
;:�� CREDIT/STANDARD DEDUCTION Hcio
State Form 5673 (R2 / 5-92)
5���•
INSTRUCTIONS: See �everse side !or liling inst�uIXions.
�� We) _��QV thatP�th�tat �March, 79_
'e) occupied as our principal place of resi ence ihe following described real property for which a Homestead Property Tau Cred� is hereby daimed:
i
❑ I(We) owned ❑ Are buyin9 under contrect /
❑ Have a beneficial interesi in ihe entiry that is liable for the property taxes on the property and thai owns ` �� 9h�o tract.
� - - s �� - COHTRACT�RECORDED ;; � . >: h; . � . - • ° -
If buying on contraR, Fee Simple owner's name
Recorder's oHice where contraa is recortled Record number Page
� � � ' � PROPEHTY DESCRIPTION ' ' � & -. ` : . �. -.. � � - �-
County Township Tauing di5tricl (dry, town. township) �
Parcel numbe Legal description -
-oi a -3- �
tl any ponion of ihe resitlential stmcture or ihe land not ezceeding one (i) aae Ihat immediatey surrounds Ihat strucNre is used to produce income, describe the use and ponion
of the property utifized ro produce income.
-i9-i.s-�a - c�/_ y�G- C1�?S
' PROPERTY OWNED�BY CLAIMANT IN OTHER COUHTIES � � ��� �
Counry Township County Township
..areby certiry ihe above statements are tme, correct and complete. � naf re o dai n2
Adtlress (number and sveet. ary. stafe. ZIP code) n-�� �O ����
����i
�' -� ASSESSOR USE ONLY , TRUE TAX ASSESSED HOMESTEAD �� , NON-RESIDENTIAL°, `.
� VALUE' VALUE VALUE., VALUE -
land noi exceeding 7(one) acre immediately �--
surrounding residential improvements. (�) � �
Other land (p) ,. �., �
Total land (line 7 plus line 2� (3)
Dwelling (4) � ' . �
Residential improvements . . . .
Garage (5) � ..
Other improvements (6) �
Total improvements (line 4 Ihrough line � (7)
Total value (line 3 p�s line n (g)
I hereby certify ihe abOVe i5 Inle, COrrect, and SignaNre of Assessor Date signed
complete.
�tyi(g aaion - Sgnature of Audiror Date signetl
19_Pay19_
Lesser of 1/2 Homesiead
Valuation or $2,000
$