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e� '� CLAIM FOR HOMESTEAU PROPERTY TAX
iE�� CREDIT/STANDARD DEDUCTION
�.�p :;��� State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side lor7iling instructions.
FORM NEAR
HC70
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I IWe) o����77��_ _� !_�Q.1��-� � .. certify thai on the lst day of March. 19
�) ed as ourArin ; al pp� lace of yysidence the following described real property tor which a Homestead Property T'x Credit is herebtiy�,daime_ds.
c.r t.a.sc•Y�u. �� .cr
I(We) owned ❑ Are buyi:��:nd2er contrect AUDITOR�
❑ Have a beneficial inter�Jh9�e�1(i.yClaf is liable for the property taxes on the property and that owns the pmperty or is buying under a contraci.
� CONTRACT RECORDED � -
If buying on contract, Fee Simple owner's name
Recortler's ottice where contract is recortletl qecortl number Page
Counry
Parcel
I( any portion of
ot Ne properry i
� PROPERTY DESCRIPTION
Tmvnship Taxing disvict (ciry, town, townshrp)
Le9altle5C" tio
��5-d'- 85f �� 3-ia
�,idemial stmcwre or Ne lantl not e ceeding one (1) aue ihai immediarey surwunds that swaure is used to protluce irimme, tlesaibe the use and portion
to produce income.
�1-�4-.��, �o-�/. �s� ��� .
� PROPERTY OWNED BV CWIMANT IN OTHEP COUNTIES �-
Township Counry Tawnship
cenify ihe above statements are true, correct and complete.
and street ury, state.
�.•• '=�1
i /
� /" �.
ASSESSOR USE ONLV TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VAWE VALUE � VAWE VALUE -
land noi exceeding t(one) acre immediately
surmunding residential improvemen[s. (�� � �
Oiherland (2)
Total land (line 1 plus line 2� (3)
Dwelling (4)
Residential improvements
Garage (5� . �
Other improvements (6)
Total improvements (line 4 through line � (7) . '
Total value (line 3 pbs line 7) (g)
I hereby certify [he above is Irue, corred, and Signaare of Assessor Daie signetl
complete.
V�enfying action - Signature of Audi;or Date sgned
DEDUCTION ALLOWANCE
19_Pay�9_ �
Lesser of 7l2 Homestead
Valuation or 52.000 S