HomeMy WebLinkAboutHomestead_FullingCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5-92)
INSTRUCTIONS: See reverse side for riling instructions.
FORM
HC10
YEAR
.
CERTIF CATION STATEMENT "W" n
HB
fin• "^ r t � LUU
I (We) 1. certify that on the 1 at day of March, 19
I (We) occupied a r p palms A r ce t e Ilowin ascribe rope f wh c a Homestead Property Taz Credit is herggy c ed:
❑ 1 (We) owned f5 �! t r
-_ vying— er contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the p party and that owns the - property or is buying uncles contract.
CONTRACT RECORDED "
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township
Taxing district (pry, town, township)
Parcel number
Legal description
If any portion of the residential structure or the land not exceeding one (1 I acre that immediatety surrounds that structure is used to produce income, describe the use and portion of
the property Ofized to pmduce income -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
�.ereby certify the above statements are true, correct and complete.
Signature of claimant
Address (number and street, city, state, ZIP code) IS, x 2. O .sc� V?z Y9
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
-
Other land
(2)
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6) -
(7)
Total value (line 3 plus line 7)
(8)
1 hereby ceriity the above is true, correct, and
complete.
Signature of Assesor
Date signed
Verifying action - Signature of Auditor -
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
Valuation or $2,000
$
Signature of Auditor / l
W
Date signed ^ ��\
J ` v'W