Homestead_Wright�'� �i;�� �`�" - CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
�� State Fortn 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side lor /iling instructians.
MAY 1999
r ' CERTIFIC TION STATEMENT
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I(We) occupied as our pri ip I la e of esidence the fo�lowing d i d real property r ich a H � :�t{y';T�� r�etlit, ,�fieFetiy claimed:
❑ 1(We) owned ❑ Are buying under contract . GIBSON G���"' '
❑ Have a beneficial interest in the entiry that is liable for the property taxes on the properry and that owns the property or is buying under a contract.
� CONTRACTRECOflOED
It buying on contract, Fee Simple ownefs name
RecorOets ofFice where convact is recorCed . Record number Page
PROPERTY DESCRIPTION
Counry Township Ta�ting tlistrict (dry, mwn, rownsNp)
�/m�r _ �O Legal destnpii ' '
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It arty poNOn of Ne residential structure or Ne land rrot exceedirg one (7) acre tha[ immedi y surtounds ihat sWCtu e is used to pr ce income, tlescribe itie use and portion of
the property utilized to praduce income.
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� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTFtIES
Counry Township Counry Township
Signa' e of daimant
�ereby certify the above statements are true, correct and�complete. �'
ress (nur�yber and t, ury, state. ZIP cod � -
�t l ��- f a C,� -1- 7��
ASSESSOR USE ONLY TRUE TAX . ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land nm exceeding 7(one) acre immediately (»
surtounding residential improvements.
� Otherland (2)
Total land (line 7 plus line 2) (3) �
Dwelling (4) .
Residential improvemenis
Garage (5)
Oiher improvements (6)
Total improvements (line 4 through line 6) (7)
Totat value (line 3 plus line 7) (8)
I hereby ceRify the above is true, correCt, and Signamre ot Assesor Dare signed
complete.
Verifying aclion - Sigfature oi Auditor Date signetl
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead c�
Valuation or 52,000
5gnature of Auditw Date signetl