Homestead_Willisa� '�"� g CLAIM FOR HOMESTEAD PROPERTY TAX
;��� CREDIT/STANDARD DEDUCTION
�.:��� State Porm 5473 (R2 / 5-92)
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INSTRUCTIONS: See reve�se side /or liling instructions.
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I(We) _� l..l • �"�lxx/'� � certify thai on the lst day of March, 79 7�
��upfed as our principal place of residence the following described real propeny for which a Homesiead Pmperty Tax Credii is hereby Gaimed:
(We) owned ❑ Are buying under contract �� ��
❑ Have a beneficial interest in the entity that is liable for ihe pmperty tazes on the property and thai owns the r i' uyin � raci.
If buying on contraci. Fee Simple owner'S name
ReCOrdefs oflice where contract is reCOrded
County
Partel number
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If any ponion of
o( the pmperty i
CONTRACTRECORDED
PROPERTY DESCRIPTION
tawn, fownship)
Page
ssa-o� i � `�N� aa-3-�► �. s3�
;idential stmcture or the land not exceeding one (1) acre ihat immediatety surmunds that structure is used ro produce iricome, describe ihe use and portion
to Droduce income. .
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PHOPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township Counry Township
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�reby certify the above statements are true, correci and complete. Signa;ure of ciaiman2 ,
Addr ss Inum rarM -'•eet Gry. srate, ZlPa�de) 7/ '/Q •
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ASSESSOR USE ONLY . TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land noi exceeding t(one) acre immediately .
surmunding residential improvemenis. (�) �
Oiher land (2) .
Total land (line 7 plus line7� (3�
Owelling (4)
Residen�ial improvements
Garage (5)
Other improvements (6) �
Total improvements (line 4 through line � (7) I
Total value (line 3 p6s line � (g)
I hereby Certify the abOVe is irue. CorreCt, and Sgnature of Assessor �ate signed
complete.
Veritying action - Sgnamre ot Audiror Date sgned
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