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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / 5-92)
INSTRUCTIONS: See �everse side lor /iling instructions.
FORM
HC70
YEAR
CERTIFICATION STATEMENT
I(VJe) certify that on the 1st day of March, 19_
I(We) occ d as our pri ci I a e of residence the tollowing described real property for which a Homes a �e Tax Credit is hereby claimed:
❑ I(We) wned ❑ re buying under contract � �J ' �
❑ Have a beneficial interest in the eniity that is liable for the property taues on the property and that owns the property�o 75 b� er � contract.
NOV
CONTRACTRECORDED
If buying on contract, Fee Simple owners name
Recorders omice where contract is recorded Nu�IT�R Page
PROPERTV DESCRIPTION �
Counry . Township � Tauing disMci (ciry, rown, township) I
Parp�l n�b� w � � Legal descnption � — ^ ' `l _� ` � � '
'U U � V {�/
If any ponion ot Ihe residenGal swcture or the land noi exceedinq one (7) acre that immediately su oun that swaure is used to proAuce income, Aescnbe Ne use and portion ol
Ne properry utilizetl to praduce income.
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTRIES
Coun Township Counry Township
Sig tur f daimant
ereby certify the above statemen!s are true, correct and complete.
Addr ( umber ar}{street, city, state, ZIP code I
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding 7(one) acre immediatety �� �
surrounding residential improvements.
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5) �
Oiher improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify [he abOVe is true, correCt, and Signature ot Assewr Date signetl
complete.
Veri(ying action - Signawre of Auditor Date signed
. STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead c�
Valuation or 52,000
SignaWreotAUtlilor . \ �{�is�9^� _O�
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