HomeMy WebLinkAboutHomestead_PflugE �.�
aE "' ; CLAIM FOR HOMESTEAD PROPERTY TAX
s� '� CREDIT/STANDARD DEOUCTION
�, State Fortn 5473 (R2 / 5-92)
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INSTRUCTIONS: See ieverse side lor filing instruttions.
FORM
HC10
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��) . . � - . .. . . certifY��gh�ist ��. 79_
�u� d as our rinci al lace of reside the follow described real ro ert for which.a Homesiead fl H
p p p p p p y per� Tat Gle it i h e daimed:
,J I(We} owned ❑ Are buying under contracL - �A�,� O_� ���� :
!'UY
❑ Have a beneficial inierest in the entity lhat is 1ia61e for the property taxes on the property and that owns ihe property or is b yi der a contract.
If buying on contract, Fee Simple owner's name
Recortler's oflice where tontrad is recorded
Counry
Township
RECORDED
Ta�ing
Record number � Page
. � - _' ' � . ' ' Y��1 -
F�e�p�ber.O ^'� � ^ Q legal description .
J ��� � U
i o,
It any portion of Ne resitlential strucNre or the IaM not exceeding one (1) acre that immetliatety surmuntls tha� structure is used to produce income, describe the use and portion
of Ne property u:ilized to protluce income. „
PROPERTY OWNED BY CLAIMANT IN OTHER COUN'fIES
County
eby certify the above statements are true, correct and complete.
Atltlress (number arM slreef, aty, slate. ZIP code)
,l_1�1 5 ,Lla// C1_ �r��so-�
ASSESSOR USE ONLY
Land noi exceeding 1(one) acre immediately
surrounding resideniial improvements.
Otherland
Total land (line 1 plus line Z�
Dwelling
Resideniial improvements
Garage
Oiher improvements
Total improvements (line 4 through lina �
Total value (line 3 pLs line �
I hereby certify ihe above is true, correct, and
complete.
19_Pay19_
Lesser of t/2 Homestead
Valuation or $2.000
TRUETAX I ASSESSED
VALUE VALUE
l�)
(2)
(3)
(4)
(5)
(6)
I�I
(8)
Sgnature of Assessor
STANDARD DEDUCTION ALLOWANCE
S
HOMESTEAD ( NON-RESIDENTIAL '
VALUE' VAWE
Date signed
Date Signetl
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