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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fo�m 5473 (R2 / 5-92)
INSTRUCTIONS: See �everse side !orliling instructions.
FORM
HC10
YEAR
CERTIFICATION STATEMENT '
I(We) S c�serti that ay of March, 19_
I(We) occupied as our principal place residence the following described reat property for which a H�� �pert�c� is hereby claimed:
❑ I (We) owned ❑ Are buying under contract '� " � � ��
❑ Have a beneficial interest in the entiry that is liable for ihe property taxes on Ne property and that owns ih@ p�opQrh 6t�ying under a contract.
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CONTRACTRECORDED
If buying on conVact, Fee Simple owners name
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Recortlefs oHice where contract is recorded C! ° Record number Page
PROPERTY DESCRIPTION
Couniy � � TownsFtip �� �� Ta�cing districl (ci ,�Wwnship)
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Parcel mber Legal descrip6on
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If arry portion oi ihe resitlentlal siruc[ure or ihe land not exceeding one (1) acre ihat immedatey sunounds ihat strucNre is used to produce inwme, tlescribe the use antl portion of
Ne Properry uNized ro Produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Caunry � Township
Signatu claimam
;ereby certify the above statements are true, wrrect and complete.
Atldress (number ands ee(, ci , s fe, ZIP code)
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE�
Land not ezceeding 1(one) acreimmediately ��� �
surrounding residential improvements.
Oiherland (2)
Total land (line 1 plus line 2) (3)
Dwellin9 (4)
Residential improvements
Garage (5)
Oiher improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby CeRify the above is true, correCl, and Signamre of Assesor Date signed
complete.
Veritying aclion - Signature of Auditor Da[e signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
Valuation or S2.o00
Signature ot Audiror Dat�igneq-' ��
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