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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
51ata Fofm 5473 (R2l S92)
INSTRUCTIONS: See reverse side /or /iling instructions.
FORM YEAR
Cto
�� ERTIFICATION STATEMENT —
�
I c to 7 t� ofMa ,1
I(VJe) occupied a r principal place of residence the following d cribed real property for which a Homestead ��T ,,a � qUD1T � ed:
❑ I(We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the properry and that owns the property or is buying under a wntract.
CONTRACTRECORDED
It buying on contract, Fee Simple ownefs narne
Recorders oXice where conVact is recortletl Recortl number Page
PROPERTY DESCRIPTION
Counry Township Tacing tli5tdct (ciry, ro� , town '
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Pyce� num r � � Legal descrip � � / / �� / � /
r(j� 660_ r+��� �� ��
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It any portion of the residenlial 5trucNre or fhe land not exceeding one (1) acr at imm�a.ey surtountls that sWC[ure is used to produce income, descnbe Ne use antl portion oi
the property utllized to 0�«luce income. ��
��-033 /� - i`oo-Q6/.1o�4-4d�- .
PROPERTY OWNED BV CLAIMANT IN OTHEH COUNTRIES �
Counry Township. Counry Township
' reof.daimant
�reby certify the above statemen!s are true, cortect and complete.
s(number and street, ciry, state, ZIP aode)
�` 5 F � � 4 3
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD � NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding t(one) acre immediately (� �
surrounding residential improvemenis.
Otherland (2) �
Total land (line 7 plus line 2) (3)
Dwelling (4)
Resideniial improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 fhrough line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby Certify the above is Irue, coveCt, and Sigtature ot assesor Date sgned
complete.
Ventying action - Signawre of Auditor � Date signetl
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 7/2 Homestead - S
Valuation r $2,000
Signature ol ditor Date s�etl � ^
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