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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Portn 5473 (R2 / 5-92) -
FORM
HC10
YEAR
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INSTRUCTIONS: See reverse side lor filing inshuctions. �j i�j 1 i
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� CERTIFI A N STATEMENT
I(VJe) �— v C—+� � c�yth�l oh th�i�Yday of March, 19_
I(VJe) occupied a our principal place of residence the fo owing described real property for which a Hom/e'stead Property Ta�Cred^t i her claimed:
❑ I(We) owned ❑ Are buying under coniract �( -� `��
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❑ Have a beneficial interest in the entity that is liable tor the property taxes on the propeny and [hat o� �operty�or�r3 tiuyiag urnier a wni2ct.
CONTRACTRECORDED �
If buying on conVaa, Fee Simple owners name � -
Recorders office where coniract is recorded � Record number- � Page
PROPERTY DESCRIPTION
Counry Township Tazing tlistrict , rown, township)
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D�n�unber Leqal description
6 -o�
Ii arry portion ot ihe residential swcture or the land no[ exceeding one (7) acre that immedatety surtountls ihat swciure is used to produce income, describe ihe use and portion of
the property ulilized [o protluce incame.
� PROPERTY OWNED BY CLAIMANT IN'OTHER COUNTRIES
Counry Township Counry _ Township
Siqnature of cla"unani
�zreby certity the above statements are true, correct and complete. a�^
Address (number ana sfreeG ciry, stale, ZIP code) '
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately ' ��)
surrounding residential improvements.
Oiherland (2)
Total land (line 7 plus line 2) (3)
Dwellin9 (4)
Residential improvements
Garage (5)
Other improvemenis (6) �
Total improvements (line 4 fhrough line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby Certify the above is true, CArreCt, and Si9nature of Assesor Date signed
complete.
Veritying ac6on - Si9namre of Auditor Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
sse f 1/2 Homestead 5
aluation or 52,0 0
Signature of Autlitor / Date signed
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