Homestead_WoehlerT
s%�""4, CLAIM FOR HOMESTEAD PROPERTY TAX
se�: CREDIT/STANDARD DEDUCTION
`.,,�.`�� StateForm5e73(R2/5-92)
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INSTRUCTIONS: See reverse side tor liling instructions.
STATEMENT
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I(We) _��—���,A s�y1��� � 02 R�l_ �yA�'� • certify� that on the 7 st day of March. 79
) occupied as our principal plade of residence the following described real property tor which a Homesiead Property Tax Credit is hereby daimed:
� I(We) owned ❑ Are buying under contract
Have a beneficial interesi in ihe eniiry that is liable for ihe property taxes on the property and that owns the property or is buying under a contract.
� � - CONTRACTRECORDED - � � ��
If brying on contracC Fee Simple owner's name
Recordefs otfice where contrad is recorded Record number Page
Counry
ParCel number
PROPERTY DESCRIPTION �
7ownship Tazing disVict (ciry, fmvn, township)
IA _ '__
Leqal tlescription
ot the residennal strucwre or the land not exceeding one (7 � acre that immediatety wrrouMs that siruaure is used to produce income. tlescribe lhe use arM portion
y utilizetl to produce income. �
PROPERTY
TownShip
certify the above statements are true, correct and complete.
Address (numberandstreeC ciry, state.
BY CLAIMANT IN OTHER COUNTIES. .
Caunry
Signature
Township
ASSESSOR USE ONLY TRUE TAX ASSESSED NOMESTEAD NON-RESIDENitAL
. .VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately
surrounding residential improvemenis. (�) ' .
Other land (z) �
Total land (line 7 plus line 2� (3)
Dwelling (4) � � -
Residential improvements .
Garage (5� � • �
Other improvemenis (6)
Totai improvemenis (line 4 Ihiough line � � (7)
Total value (line 3 p�s line � (g)
� hereby ceRify lhe above is irue, CorreCl, and Signature ot Assessor Date signed
complete.
�ing aaion - Signature of Auditor ' Dare signed
19_Pay19_
Lesser of 7l2 Homestead
Valuation or 52.000
STANDARDDEDUCTIONALLOWANCE �
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