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e � CLAIM FOR HOMESTEAD PROPERTY TAX
a,�� CREDIT/STANDARD DEDUCTION
�;� � Stare form 5473 ({i2 / 5-92)
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INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
YEAR
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�I iWe) U,�J( /�!I C. 1 �\�U/�d�(,/WC '�l /Y VY /l �—�-�' ��,�`JCJ�K- cenify �hat on the �st day ot March. t9
e�cupied as our principal place of residence the following described real property for which a Homestead Pmperty Tax Credit is hereby claimed:
Q I(We) owned ❑ Are buying under contract
❑ Have a beneficial interesl in ihe entiry that is liable (or the property taxes on the properry and that owns the property or is buying under a contrac�.
II buying on crontraa. Pee Simple owner's name
Recorder's otllce where contran is recordetl
County
Township
CONTRACT RECORDED
PROPERTY
Page
�a r�W o01�n�'� � I legal tlescripiion
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�1��, �� t
II any portion ol�tl e e�sitlential slroaure or Ihe land not e.ceeding one ( t 1 acre �hai immetlla�ety surmunds ihat stmcture is usetl io protluce income. describe the use and ponion
of �he property milizetl to produce income.
PROPEflTV OWNED BV CIAIMANT IN OTHER COUNTIES
Counry
eby cenity the above statemems are true, correct and complete. �
Address (number and streel. ciry. s�a(e. ZIP rode^ i� V
ASSESSOR USE ONLY
Land no� exceeding 7(one) acre immediately
surrounding residential improvemenis.
Oiherland
Total land (line 7 plus line7�
Dwelling
Residential improvements
IGarage
Other improvemems
Total improvemen�s (line 4 lhrough lina 6�
Total value (line 3 p6s line 7�
I hereby certify the above is true. wrrect. and
complete.
�erifYinq action � Siqnature olAudi�or
19_Pay79_
Lesser of 7/2 Homestead
Valuation or 52.000
TRUETAX I ASSESSED
VALUE VALUE
(�)
(zl
(3)
IG)
(5)
(6)
(%1
Iel
Signa;ure of Assessor
STANDARD DEDUCTION
3
HOMESTEAD
VALUE
NON-RESIDENTIAL
VALUE
Da;e signetl
Date signetl
� ureo�Autlitor � , � � � � IDateygned � /)
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