HomeMy WebLinkAboutHomestead_Pohla%�`R°Y CLAIM FOR HOMESTEAD PROPERTY TAX
;��� CREDIT/STANDARD DEDUCTION
`,.�.`�� S�ate Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side !or liling instructions.
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(�� FORM YEAR
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cert that on h�t$t � h, 19
for which a Homeste r eau i�]��s he�r�eby daimed:
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U I(We) owned ❑ Are buying under contract � .
❑ Have a beneficial interest in the entiry ihai is liable for the property taxes on ihe property and thai owns the property or is buying under a contract.
CONTRACTRECORDED �
If buying on contract, Fee Simple owner's name � . _ �� �
Recortler's oHice where coniraci is rewrded Record number Page
Counry
PROPERTY DESCRIPTION
Township � . Taxing distric� (city. town, township)
Pa�lO�e_�I���� Leqaltlescription ��� �,, ^ �I `�_/^ ' ����
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II any portion o( ihe residential sirucwre or the land not exceeding one (7) acre thai immediatety surmunds ihat strucWre is used to produce income, tlescribe the use and portion
of ihe property utilized to produce income.
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PROPEflTV OWNED BY CLAIMANT IN OTHER COUNTIES
County Tawnship Coun�y Township
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�eby cenity the above statements are true, correct and complete. Si a�� re Caim �
Atltlr sy�numy¢�rtl '•eef. ' �. slafe, Zl� �ode) � �� �� I , ` l ��
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately
surrounding residential improvements. (�) -
Oiherland (p)
Total land (line 7 plus line 2� (3)
Dwelling (4) 2��8 20 �
Residential improvements .
. - Gara9e (5)
Other improvements (6)
Total improvements (line 6 through line � (7)
Total value (line 3 p�s line � • (g)
I hereby certify Ihe above i5 irue, CorreCt, and SignaNre of Assessor Date signetl
complete.
�ing action - Signature ol Audimr - Date signed
79_Pay79_
Lesser of 1/2 Homestead
Valuation or 52.000
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AILOWANCE