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CLAIM fOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R2 / S92)
INSTRUCTIONS: See reverse side /or /iling instructions.
FORM
HC10
YEAR `
CERTIFICATION STATEMENT � - �
I(We) �� '" cert t at t(� day_of Mamh, 19_ �
I(We) occupied as our princ' place of re ence the foliowing described real property for whichpa Hom/estead Property Ta�c Credit is hereby claimed:
❑I(We)owned Arebuyingundercontract y�%� .l /'G�O �pN 18 20U0
❑ Have a beneficial interest in the entiry that is liable for the property taxes on the property and that owns the roperty or is buyi under a contract.
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� CONTRACTRECORDED „y�,,, T .��nr R �
It buying on cantract, Fee Simple owners name '"" �"'"" ���
Recordets office where contrad is recorded Recortl number Page
PROPERTY DESCRIPTI N
Counry Township � Tazing ' , o towp5fl})
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P fcel number O/��/ O� Legal desc ti � �] �� //'� /��
G �i �h�
If any portion oi ihe resitlential siruc[ure or the lantl rnt exceeding one (7) a at immediatery surtountls that swcture is used to produce income, describe the use and portion of
ihe ProPerry utilaetl to produce i�dne.
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Couniy Township Counry Township
Signa re of daim t
ereby certify the above statemeMS are true, correct and complete.
dtlress (number and street, ciry, state, ZIP code)
�-3 rir,r
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land noi exceeding 1(one) acreimmediately (��
surrounding residential improvements.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residentiai improvements
Garage (5) '
Other improvements (6)
Total improvements (line 4 through line 6J (7)
Total vaive (line 3 plus line 7) (8)
I hereby certify the above is irue, cortect, and Signature of Assesor Date signed
complete.
Veriyin9 action - Signature of Auditor Date signetl
� STANDARD DEDUCTION ALLOWANCE
7 9_ Pay 19 _
Lesser of 1/2 Homestead �
V 1 ation or 52,000
Sign ur ot Auditor Date sig
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