Homestead_Wood (3)�E n��
aa °E CLAIM FOR HOMESTEAD PROPERTY TAX
3��: CREDIT/STANDARD DEDUCTION �
„��p .,;� State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side tor liling instructions.
FORM
HC10
0
YEAR
I� c� - . � jyLJ(J� , certif�1tnhat onn the 7 st day of March, 19_
) occupied as o r p cipal place of residence ihe following described real property tor which a H�ojmestead�6�er�y j�x � is hereby claimed:
� I (We) owned ❑ Are buying under contraci � - . , � �6 _ .
��•yyt,�� �2
❑ Have a beneticial interest in the eniity that is liable for the pmperty taxes on the property and that owns the proQerty oris buying u_ Er'atoniract.
- " � . . � � CONTRACT RECORDED._ ` � '�
It buyirg on conirect, Fee Simple owner's name � � � .
Recordefs oHice where contract is rewrded Record number Page
� � ` � PROPERTY DESC IP'TION - - - - � ' " -
Counry . Township Ta�ci dis ' � y. w t wnship)
, ber` oI � {� Legal description
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If any porti n ot the residenlial stmcture or [he Wntl nol exceetling one (1) acre that immetliatety wrrounds that strucNre is used to produce income, describe the use and portion
ot fhe pmperty utilized to protlute intome. , _ _ _
County
OWNED BV CLAIMANT IN OTHER COUNTIES�
the above statements are true, correct and complete.
state; ziP
� ASSESSOR USE ONLY . TRUE TAX _ ASSESSED HOMESTEAD NON-RESIDENTIAL
�VALUE VALUE VALUE �VALUE - -
Land not ezceeding 7(one) acre immediately •�
surrounding residential improvements (�) �
Otherland (p)
Total land (line 7 plus line 2� (3)
Dwelling (4) . .
Residential improvemenis ,
Garage � (g) � .
Other improvements (6)
Total improvements (line 6 through lina � (7)
Total value Qine 3 p6s line � (g)
I hereby Cerlify lhe above iSlrue, COrrect, and Signature of Assessor Date signed
complete.
`"��irg action - Sgnamre ot Auditor � Date signetl •
19_Pay�9_
Lesser of 7l2 Homesiead
Valuation or 52.000
5
Sgnature oi Audimr re s neo
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