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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Fwm 5473 (R2 / S92) �
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FORM
HC10
YEAR
. 1���- t7�a .
C TIFICATIO STATEMENT f' `' ��I _ �;� �� ��
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I(We) certity ihat on the 1st day of March, 19_
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I(VJe) occupied as our principal place of residence the follovring described real property for which a Home��P��iy��C�redit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract -- �� � � , �
❑ Have a beneficial iNerest in the eniity fhat is liable for the property taxes on the property and thh�at4we tfie property or is buying under a contract.
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CONTRACTRECORDED
It buying on contract, Fee Simple ownets name �
Recoraels otfice where conVact is recorded - Record number Page
PROPERTY DESCRIPTION
Co Township - Taxing tlistriq (dN. ' i y�^ . .
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a I number Legal tlescri ' n
� - 3� � Of %.
If any portion of the residential sWCture or ihe land not exceedinq one 1) acre that immediatey surtountls that siructure is used to produce income, describe Ihe use and portion of
the properry utilized ro produce income. �
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
i e of I� ant�
,ereby certity the above statements are We, correct and complete.
Ad ess umber and s1ree7, city, sla(e, ZIP code)
�0B 75�7 5 ' S�t/ � 46�
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VAIUE VALUE VALUE
Land not exceeding 7(one) acre immediatery (� �
surtounding residential improvements.
Otherland (2)
Total land (line f plus line 2) (3)
Dwelling . (4)
Residential improvements
Garage (5)
Other improvements (6)
Tota6improvements (line 4 through line 6) (7) _
Total value (line 3 plus line 7) (8)
I hereby certify Ihe above is true, correct, and Signamre of Assewr . Date signetl
complete.
Verifyiig acGOn - Signature of Auditor Date signed -
� STANDARD DEDUCTION ALLOWANCE '
19_ Pay 19 _
Lesser of 1/2 Homestead � - ,
Valuation or 52.000
SignaWr Audi:or Daresigncd
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