HomeMy WebLinkAboutHomestead_Young (9). � - -
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c� °„ CLAIM FOR HOMESTEAD PROPERTY-TAX
_��'� CREDIT/STANDARD DEDUCTION
.�`��� State Form 5473 (R2/5-92)
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' INSTRUCTIONS: See reverse side far7iling instructions.
I (We) W V�
I.(We) occupied as
Have a beneficial interest in the
— FORM
HC10
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��ERTIFICATION STATEMENT � � • ' �� � �
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°F'�,Q,�,� � certify thai on.the 1si day of March, 79_
[IL C Cj 'S
described real pmperty for which a Homestead Properfy T�CreaII is��eby claimed:
operty taxes on the pmperty and ihat owns the prop�rt�orj5,t�iing0.i�"iclgrqcontrect.
� PROPERTY DESCRIPTION - '-
Counry . Township . Ta��g disiria (ciry., n. rownship) �.
1�
Parcel number Legal tlescription
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If any ponion ot Ihe residen6al strucNre or Ne lantl not exceeding one (7) aae thai immetliatety surtounds that sWCture is used [o produce income. describe Ne use and ponion
of the property utilizetl to protluce income.
ASSESSOR USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residential improvemenis.
Otherland
Total land (line 1 plus line 2�
Dwelling
Residential improvements
Garage
Oiher improvemenis
Total improvements (line 4 throvgh lina �
Total value (line 3 p�s line 7�
I hereby certify the above is irue, correct, and
complete.
Veritying aaion - Signamre of Audiror
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19_Pay19_
Lesser of 7/2 Homestead
Valuation or 52,000
THUETAX I ASSESSED
VALUE VALUE�
(�)
(z)
(3) .
14)
(5)
(6)
(�)
(8)
SignaNre of Assessor
STANDARD DEDUCTION
S
HOMESTEAD I NON-RESIDENTIAL
VALUE VALUE
Dale signed
Date signed
Sgna[ure of Autlitor I Date Signed
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