HomeMy WebLinkAboutHomestead_Johnson (13)�..a ��R
e�/=" � CLAIM FOR HOMESTEAD PROPERTY TAX
;���;"s CREDIT/STANDARD DEDUCTION
., � ;;� Sta�e Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side lor Iiling in5truction5.
FORM YEAR
HC70
_ �
..I � 1 (((111 /
'e) � T � certify that on the da of Ma,(r�� 7��
�) occupied as our principal place of idence ihe tollowing ribed real�property for which a Homesiead Property Tax r i iy� ie�nds� "S
�� vriv
�I(We) owned ❑ Are buying under coniract .
Have a beneticial interest in the entity ihat is liable for the propeny taxes on ihe propeny and that owns ihe property or is buying under a contraci.
. CONTRACTRECORDED � �
If buying on wnVaci. Fee Simple owner 5 name _ . ,
Recortler's oHice where contrect is recortled Record number Paqe
Counry
Parcel number
00(� -'03�
If any portion of the resitl
of the property utilizetl to
Legal
structure or Ihe land not
ice income.
acre that
Taxing
�.���
surmunds ihat swcture is used to produce income, descnbe ihe use and portion
ASSESSOR USE ONLY . THUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VA�UE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately
surrounding residential improvemenis. ��)
Other land (p)
Tmal land Qine 7 plus line7) (3) I
Dwelling (4) �
Residential improvemenis
Garage (g)
Other improvements (6)
Total improvements (line 4 through lina � (7) -
7otal value Qine 3 p6s line 7� -�g)
I hereby certify the above is irue, correci, and Signature of Assessor Dace signed
complete.
��=ritying aaion - Signa;ure of Audi;or Date signetl
�
19_Pay19_
Lesser of 7l2 Homestead
Valuation or 52.000
SignaWre ol Autlitor
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