HomeMy WebLinkAboutHomestead_Prinzing (4)���` `�„` - CLAIM FOR HOMESTEAD PROPERTY TAX
: CREDIT/STANDARD DEDUCTION
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1 ..�� Siate Fortn 5473 (R2 / 5-92) .
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INSTRUCTIONS: See reverse side (or filing instructions.
FORM
HC10
YEAR
o��a�
CERTIFICATI N STATEMENT �
I(We) �Z/ � � 0� ,� certify Ihat on the 75t day of Mamh, 19_
I(VJe) occupied as our principal place of residence the II 'n9 described real propeAy for which a Homestead Properry Tax Credit is hereby ciaimed:
❑ I(VJe) owned ❑ Are buying under contract
❑ Have a beneficial interest in�the entiry that is liable for the property taxes on the property and that owns the p 's- ying a nt t.
CONTRACT RECORDED
If buying on contract. Fee Simple ownefs name O�'I �QO
MAR �
Recorders office where contract is recorded � � ecord num age
PROPERTY DESCRIPTION COUNT �
Counry . Township Taxing tlistrict ('. wn, townshipJ"
� f� /f-i� KA ��✓ct.�.✓
Parcel number Legal description
� QQ% �—OCi
Ii arry portion of the residential structure or the lantl rrot ezceetlirg one (i) acre ihat immediatey sunounds that swcture is usetl to protluce income, Aescribe Ne use and portion oF
Ne pmDerry utilized ro protluce incame.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
CounN Township . County Tovmship
Si ture of claimant
eby certify the above statements are true, correct and complete. ` �
Atltlress (numbe�and streel, ciry, state`,�t,�,/c,a,de) r � �
� � Y'�'�w7� �� � l�"lJ
A SESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(oneJ acre immediatety �� �
sunounding residential improvemenis.
Other land (2) I
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvemenis (line 4 thiough line 6) (7)
Total value (line 3 plus line 7) ` (8)
I hereby certify the above is true, correct, and Signamre of Assesor Date signed
complete.
Verilyin9 action - Signature of Auditor Date signetl I
J � STANDARD DEDUCTION ALLOWANCE
19 Pay 19 _
Less r of i/ estead S �
V uaC n or 2,000
Sigriature ot AWiror Date signed
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