HomeMy WebLinkAboutHomestead_Hardiman (16)��`���" - CLAIM FOR HOMESTEAD PROPERTY TAX
° CREDIT/STANDARD DEDUCTION
�� ��_�� State Fortn 5473 (R2 / S92)
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INSTRUCTIONS: See reverse side /or (ling instructions.
FORM
HC10
YEAR
� � CERTIPI�ATION STATEMENT
I(We) e fy at the 1 t d M , 79_
I(We) occupie as our pnncipal place of residence the following described real property for w ich a Homes Pr ax re i is ereby claimed:
❑ I(We) owned ❑ Are buying under coniract NQ� 1% Z�Q�
❑ Have a beneficial interest in the eniiry thai is liable for the property tazes on ihe properry and that owns the property or is b" under a contract.
CONTRACTRECORDED
If buying on convaa, Fee Simple owners name ''
Recortlers offce where contract is recorded - Record number Page '
PROPERTY DESCRIPTION
Counry Townshi0 Tamg dis[rict (dry, fown, tamship) '
Pa I ber � � �� � Legal descAption � ('� � ` r� I I , � � ^ �
\ a Cj� ��
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h any porti n of Ne residential strucwre or the fand not exceeding one (7) acre ihat immediatety sunounds that sWtlure is usetl to protluce income, descnbe Ihe use and portion of
ihe property util¢etl to protluce incame.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township . Counry Township
ignat e of imanl
ereby certify the above statements are true, correct and complete. ,r1 �`� •
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Address umbeiantlstree(,ciry,state,ZlPCOtle)
/j3 /.jnx �� f /'i' e o� 1�1'i 5/7�?D
ASSESSOR USE ONLV TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
nd not exceeding 7(one) acre immediately (»
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 6J (7) �
Total value (line 3 plus line 7) (8)
I hereby certify the above is Irue, correct, and Signature of Assesar Dare signed
wmplete.
Verilying action - Signa[ure ot Auaitor Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
Valuation or �2,000
Siqnature of Auditor , \ Date s;gned /�'�/�
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