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i: CREDIT/STA DARDTDE UCTI�ON RTY TAX
' =�r Siate Form 5473 (R2 / 5-92) .
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INSTRUCTIONS: See reverse side lor �ling instructions.
FORM
HC10
YEAR
I (We) � � ���/�� — U `S certif���,g(�,�-(� �a� of March, 19_
I(We) occupied as o r principal place of residence the following descnbed real property for which a Homestead ProperyTan C�it is hereby aimed:
❑ I(We) owned ❑ Are buying under contract . �: �___ �
❑ Have a beneficial inierest in the entiry that is liable for the property taues on the property and that ow `�' � or'is'b� n @ conVact.
7�.���(`y:. � . , s�,�ct�
contracl, Fee Simple ownefs name
Recorder s office where conVacl is recorded
CONTRACTRECORDED
DESCRIPTION
township)
Pa�/�qe�, /^�_� �Legaldescriptiory� \/�/ \- .,( }7� �� ( � L
U \L �� D' II / L 1 1��'/ 1'�J�
� � S��x.o.i � x i �
If any poNOn of ihe resitleniial siructure or che land not e:ceedmg one (1) acre i at immediatety sunounds iha[ sWCture is used to
Ne property utilaetl ro produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry
`ereby certiry the above statements are true, wrrect and complete. �
lf2
�A ss (numberantl streeG ciry, sfate, ZIP e)
� G jta o,� ✓L�t� c�-�. �f 7G 7 0
ASSESSOR USE ONLY �UETAX ASSESSED
. VALUE VAIUE
Land not ezceeding 1(one) acre immediately I(� �
surrounding residential improvements.
Oiherland (2) -
Total land (line 7 plus line 2)
Residential improvements
Other improvements
(3)
Dwelling (4)
Garage (5)
(6)
Total improvements (line 4 through line 6)
Totat value (line 3 plus line 7)
I hereby certify the above is irue, correct, and
complete.
19_ Pay 19 _
Lesser of 1/2 Homestead
Valuation or 52,000
l�1
IB)
STANDARD DEDUCTION ALLOWANCE
$
HOMESTEAD
VALUE
use
NON-RESIDENTIAL
VALUE
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