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e.�� � CLAIM FOR HOMESTEAD PROPERTY TAX �;�' _-- .FORM VEAR
,?�= CREDIT/STANDARD DEDUCTION � -�HCio";1-„�
�,` � State Form 5473 (R2 / 5-92) �
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INSTRUCTIONS: See reverse side /or liling instructions. -
I(We) . �(,ej(�_�_� (��(,C.,(l� � certity Ihai on the lst day of March, 19�
�) occupied as r principal pl o residence the tollowing described rea��pmperty for which a Homestead Pmperty Tax Credit is hereby daimed:
�� I(We) owned ❑ Are,buying under coniract � �
.Have a beneticial interest in the entity ihat is liable tor the property taxes on the property and that owns the property or is buying under a contract.
- �� CONTRACTRECORDED -�
It buying on contracC Fee Simple owner's name , � .
Recorder's of;ice where contraci is recorded Record numher Page
PROPEflTV DESCRIP'T10N
Counry � Township . Taring district (dty, town, townstip)
Pamel num r Legal de5tription
b �O 5 5 � �
If any portion o( ihe residential stmcture or the land not exceeding one (7) acre that immediatety
of Ne pmpeny milized to produce income.
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that structure is used m produce income,
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PROPERTV OWNED BY CLAIMANT�IN OTHER COUNTIES �
County Township County Township
�eby certify ihe above statements are true, correct and complete. Sig t e of clai m
�'•zss (number and sbeet. dry, state, ZIP cotle)
the use and ponion
ASSESSOR USE ONLY TRUE TAX � ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE- VAIUE VALUE
Land not exceeding 1(one) acre immediately �
surrounding residential improvements. (�)
Otherland (2)
To[al land (line 1 plus line 2� (3)
Dwellin9 (4)
Resideniiai improvements
Garage (g� .
Other improvements (6)
Total improvements (line 4 th�ough lina � (7)
Total value (line 3 p�s line 7) (g)
I hereby certify ihe above i5 �rue, CorreCi. and Signature ot Assessor Date signed
complete.
� ing action - SignaWre of Audiror Date signed