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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sta[e Fartn 5473 (R2 / S92)
FORM
HC10
YEAR
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INSTRUCTIONS: See reverse side /or liling instructions. ,
CERTIFICATION STATEMENT �
I(We) certify that on the 1 st day of March, 19_
I(We) occupied as our principal place of residence the following described real property for which a Homestead Prope Tax Credit i he y claim :
❑ I(We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entiry that is Iiabie for the property ta�ces on the property and that owns the pro � `� d8! _ A
� CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recordefs oflice where convact is recortletl - Record number Page
PROPERTY DESCRIPTION
Counry TownShip Taxing disirit� (ciry, town, fownshipJ
Parcel number - Legal descnpGOn / j �
- � �= C� zL - - `
y poNOn of the resitlential swciure or Ihe land not ezceetli q one (1) acre that immediate�y sunountls that strudure is usetl to produce income, describe ihe use and poNOn of
the property utilizetl ro produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
S� naWr of claimant
�ereby certify the above statements are true, correct and complete.
Address (number and sneet, ciry, state, ZlP code) '
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (»
suvounding residential improvements. .
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8) .
I hereby certify the above is true, correct, and Signature ot Assesor Date signed
comp�ete.
Verifying action - SgnaNre ot Auditor Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 7/2 Homestead �
Valuation or 52,000
Signature of Autlitor Date signed
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