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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
S�ate Fortn 5473 (R2 / S92)
FORM
HC10
YEAR
�� INSTRUCTIONS: See reverse side /or (iling inshuctions. p ��� �• ` � �
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��`. ERTIPICATION TATEMENT ��`�'�
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I(We) certiy that on ih�'f51'day of March, 19_
I(We) occupied as our principal place of residence the following des ed real property for which a H rpestead Prop/e�ty a�Y Credit is hereby claimed:
❑ I(We) owned ❑ Are buying under contract ���� �y� ��%Y ..ti�
❑ Have a beneficial in[erest in the entity that is Iiable for the property taxes on the property and that owns the property o7'is buy,ingJ��a cont2ci.
CONTRACTRECORDED
If buyinq on contract, Fee Simple owners name .
Recorders ottice where contrad is recortletl Record number Page
PROPERTY DESCRIPTION '
County Township Ta�dng is "c town, fownshipJ
Parcel mbe��� � � �egal scription /'� - � � /
�01(,(lJ
If any portion of Ne residential strudure or the tantl not ezceeding one (1) acre that immed�ately surtountls that s[ruciure is used to produce income, describe the use anA portion ot
the pmperry utllized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry ' Township
Si nature o aimant
ereby certify the above statements are We, correct and complete. � `
Atlaress (number and siree(, dry, s(afe, ZIP code) �
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding t(one) acre immediatety (� �
surrounding residential improvements.
Other land (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, correct, and Signawre of assesor oa2e signed
complete.
Verifying action - Sgnature of Auditor _ Date signed
�� STANDARD DEDUCTION AILOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead c�
Valuation or 52,000
Si aWre utlitor Da[e signed