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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92) '
INSTRUCTIONS: See reverse side (or (ling instructions.
FORM
HC10
YEAR
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\ CERTIFICATION STATEMENT .�.- � -�,
1 � �� , 1'
I (We certify tha� h�ts�ay,ot �ar��J9_
I(We) pied as our princ' place of residence the oll wing described real property for which a Homestead Prope ax C�/redit is hereb� claimed:
I(We) owned e buying under contrad '�1 � � 200"
❑ Have a beneficial interest in the entity that is liable tor the property faues on the property and that owns the property or is buying und��Er a coni/2�ct.
i 74...1(
CONTRACT RECORDED �_ �,.T•;�. �,^�77;; '
It buyinq on contracl, Fee Simple owners name ° � �.�� ?�' "' '� �
Aecorders affice where conUact is recordetl RecorC number Page
PROPERTY DESCRIP N
Counry Township Ta:ing di tri (ci to�vn, t ship) �
6er , O al description
If any ponion oi the resitlential sirucWre or Me land not exceeding one (1) acre that immedarey surtounds that structure is used ro produce income, describe the use and portion ot
ihe property utilized to protluce incame.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Townshi County Township
Signature of claimant
iereby certify the above statements are true, correct and complete. �
I Address (numbe� antl snee6 ciry, stare, ZIP cotle) '
5 S - -�-�-�-/�G 7d
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
� VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately (��
surroundin9 residenrial improvements.
Otherland (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 (iine 3 plus line 7) (8)
I hereby certify the above is true, wrreCt, and Signamre of nssewr Date signea
complete.
Ventying actim - Si9naNre of Auditor Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 7/2 Homestead �
� Valuation or 52,000
SignaNre oi Auditor Date signetl