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eE °, CLAIM FOR HOMESTEAD PROPERTY TAX
_��'= CREDIT/STANDARD DEDUCTION
,�;=��� - State Porm�5473 (R2 / 5-92)
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INSTRUCTIONS: See ieverse side /or filing instructions.
_ � . . � CERi7FICATI
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FORM YEAR
.�.H�cio
� s. �
” Idt�- �1 1445
I(We) 4.J `�Y—�-Y�� SLSi! V��C+LJ�.A--hJ �� certity'.�Aa. Woukea5tT�da pefk{2^re�, 19
"Ne) occupied as our rin � al p��e of res nce the following desaibed real property for which a Homesiead Properf�ia�re 4B hereby Gaimed:
�I (We) owned ❑ Are buying under contract , � .
Have a beneficial interest in the entity that is liab�e for ihe property taxes on the property and that owns ihe property or is buying under a contract.
� CONTRACT RECORDED . � . � _
I( buying on comract. Fee Simple owner's name.
Recorder's oflice where contract is recorded
Record number � Page
� PROPERTY DESCRIPTION �
Counry . Townsttip Taxing disvict (ciry, fowq rownship) „
Pareei number `' . Legal description
� d \
It any portion of ihe residential structure or the lantl not e:ceeding one (1) aue ihai immediatety surrounds that swaure is used �o protluce income, describe ihe use and portion
of the pmperty utilized to produce income.
- /,Q= :�?� - -��O ^ 6G�. ��%S-Qo�s
ASSESSOA USE ONLV � TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL�
. -VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately
surrounding residential improvements. (�)
Otherland (p)
Total land (line 7 plus line 2� (3) I
Dwelling (4) ( � ' ,
Residential improvements .
Garage (5) <.
Other improvements (6) -
Total improvements Qine 4 through lina � (7)
Total value (line 3 p�s line � (g)
I hereby certity the above is irue. correci, and Signawre of Assessor Date signetl
complete. �
Ventyirg action - Sgnamre of Audiror Date signetl
�
STANDARD DEDUCTION ALLOWANCE
� 79_Pay19_
Lesser of 1/2 Homestead
Valuation or $2.000 S
Signature of Audimr Date signed