HomeMy WebLinkAboutHomestead_Worthingtone'`""- CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
�� ���'� State Fortn 5473 (R2 / S92)
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INSTRUCTIONS: See reverse side far liling instr�ctions.
FORM
HC10
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CERTI I O T ENT
I(We) rtiy that on e st a of March, 19_
I(We) occupied as our principal place of residence the follo ' described real p operty for wh' h a Homestead Pmoe{ty�faq&vdit is hereby claimed:
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❑ I(We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entiry that is liable tor the propeRy taues on the property and thai s the p ope or uying de contract.
CONTRACTRECORDED �
Ii buying on convad. Fee Simple ownefs name
Recortlets office where contract is recordetl Recortl number Page
PROPERTY DESCRIPTION
� Township Taxing di51ri (dry. 0 tow shi ^
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Parcel number � ^ Legal description � ^ � /� — ^ �/
� l V � � o(�
1 any portion of Ne resitlen6al siruaure or �he IanO not exceetling one (1) acre Ihat immedately sunounds ihat structure is used m protluce income, describe Ne use and portion of
the Droperty uulizetl to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township , Counry Township
re of daunant
.ereby certify the above statements are true, correct and complete. M�
Atldre um6erandstreet,ciry.state,ZlPcode)
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land noi exceeding 1(oneJ acreimmediately ��)
surrounding residential improvemenis.
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, cortect, and Sgnamre of nssesor Da�e signed
complete.
Venfying acfion - SignaNre of Autlitor Date signetl
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
aluation or S2,000
Signa re Autlita . Date si etl
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