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4� °� CLAIM FOR HOMESTEAD PROPERTY TAX
;��': CREDIT/STANDARD DEDUCTION
.�,`;� State Fortn 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side /or7iling instruc(ions.
FORM �EAR
HC10
I(We) �L��I/,1a4 1//b11�C,/l.�,X/L � certifyth t da 79
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) occupied as our principal place �residence ihe following described real property for which a Homestead� Pro x edit r y imed:
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LJ I(We) owned � Are buying under coniract . •- �-
❑ Have a beneficial interest in the entiry ihat is liable br the property taxes on ihe pmperty and that owns ihe pmpert�� C�JJig�r a contract.
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If buying on contract. Fee Simple owner's name
Retorder's ottice where croniract is recorded
PROPERTY DI
Coum �� Township
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Parcel number— /0���\ Le9al des ip o I i�
U �Y
If any ponion of the resitlential strucmre or the lantl not exceeding one (7) acre that
ot the pmperty utilized to protluce income.
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Record number Page
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that structure is used to produce ir�come, desaibe the use antl portion
ASSESSOR USE ONLY TRUE TAl( ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE �
Land not exceeding 1(one) acre immediately
surrounding fesidential improvements. ��)
Otherland (p�
Total land (line 1 p/us line Z� (3�
Dwelling (4) .
Residential improvemenis
Garage (5)
Other improvements (6)
Total improvements (line 4 through line � (7)
Tolal value (line 3 p�s line 7) (g)
I hereby tertify ihe above is lrue. CorreCt. and Signature ot Assessor I Date signed
complete.
�tying action - Signamre of Auditor Date signed
79_Pay19_
Lesser of V2 Homestead
� Valuation or 52.000
DEDUCTION ALLOWANCE
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