Homestead_WickerST1��e
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sta:e Fwm 5473 (R2 / S92)
INSTRUCTIONS: See reverse side lor filing inshuctions.
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CERTIFIC ON.STATEMENT �
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I(We) � certity on the4slday of March, t9 �%
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I(We) occupied as our principal piace of residence the follo ' described�real property for which a Homestead rop�g�� Creditis�hereby�laimed;
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❑ I(We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taues on the property and thai owns the property or is buying under a contract.
CONTRACTRECORDED
If buying on contract, Fee Simple ownefs name
Recorders otfice where contract is recortled Record number Page
PROPERTV DESCRIPTION
Coun Township Ta�cing distnc a,(own, township)
arcel number Legal tlescription
D �-0/s' 7 l� -�3 —/�
If any ponion of the residenfial structure or the lantl not ezceeding one (1) acre that immediatety sunounds that structure is usetl to produce income, descnbe the use and poNOn of
Ihe property utiiized to Drotluce income.
aG- - 9-3oG_GOi.9�9-o�s
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Caunry Township I
Sign ure f c � ant
�ereby certify the above statements are true, correct and complete. Aq
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Addres numberarMSneet,ciry,stare,ZlPCrode) %✓� 1 I
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding t(one) acre immediately (� �
surrounding residential improvements.
Other land (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other impmvements (6)
Total improvements (line 4 through line 6J (7)
Total value (line 3 plus line 7J (8)
1 hereby certify the above is true, wrrect. and Signawre of Assesor Date signed
complete. �
Verifying acGon - SignaWre of Audiror Date signed
�' STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 7/2 Homestead c�
Vafuat n or 52,000
Sign of Witor 5�9^ _ �