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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sta;e Form 5473 (R2 / 5-92)
INSTRUCTIONS: See �everse side /or tiling instructions.
FORM YEAR
HC10
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YM�Y �� iyy�
certif t o 1 st day of March, 19_
) occupied as our prir(cfpal place of reside c t e following described real property tor which a Homestead Pmperty Tax � edit is re claimed:
V I(We) owned ❑ Are buying under con�ract
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❑ Have a beneficial interest in the entiry that is liable for ihe property taxes on the pmperty and that o�v, s ihe property ocis b�uying.v a contraci.
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� � — � . - CONTRACT RECORDED �
It buying on contrect, Fee Simple owner's name . . - �
Recortler's ottice where coniract is recorded Record number Page
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Township
I( any portion of the residential simcture or Ihe land
ot Ne property u5lized to produce income.
PROPERTY DESCRIPI
Taxing di�
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exceeding one (7) aae that immediately surwunds ihat swcture is used to produce income, desaibe the use and portion
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Counry Township Counry Township
�eby certify the above statements are hue, correct and complete. Signamre of ciaim
d ss (number arM slree(. ary. state. ZIP code)
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ASSESSOR USE ONLY TRUE TAX %1SSESSED HOMESTEAD NON•RESIDENTIAL
- VALUE VALUE VALUE - VALUE
Land not exceeding 7(one) acre immediately
surrounding residential improvementa (�) . °
Otherland (2)
Tmal land (line 1 plus line 2� (3)
Dwelling (4) �
Residential improvements
Garege (5)
Other improvements (6)
Totat improvemenis (line 4 through�line � (7)
Total value (line 3 pbs line � (g)
I hereby Certify ihe above is Irue, correCt, and Signature ot Asseswr Date signetl
complete.
Verityinq action - Signature ot Auditor � Date signetl
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� - STANDARD DEDUCTION�ALLOWANCE '
79_Pay79_ .
Lesser ot 1/2 Homestead
Valuation or 52.000 S - �
Sig W ot Auditor Date si _� �/Q
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