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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2I S92)
INSTRUCTIONS: See reve/se side !or (ling instructions.
FORM
HC10
YEAR
-•, -1
-f CERTIFICATION STATEMENT - ' t t ��
_ .- �
a � ..�s.
I(V✓e) certity thatpn the 1st day of March, 19_
t:l" ry �-
I(We) occupietl as our principal place of r si ence the following described real properry tor which a Homestead Propecty.Tarz Credit Fs,her�by claimed:
❑ I(VJe) owned ❑ Are buying under contract J� � _ :
❑ Have a beneficial inrerest in the entity that is liable for the property taxes on the property and thai owns the�.property,or is buying under a"contract.
'_ . _ ' . --c—�-c�{�',
CONTRACTRECORDED
If Mrying on conVatl. Fee S'unple ownefs name -
Recortlers oHice where conVact is recorded Recortl number , Page
PROPERTY DESCRIPTION
Counry Township Ta�ting distnci (dry, town, township)
P�I�upipei Q� l�� Legal descnplion . �
( i
If any portion of Ne residential sirucwre or ihe land noi exceetling one (1) acre Ihat immediately sunounds that struciure is usetl to protluce income, describe Ihe use and portion of
the properry utilized m praduce income.
PROPERTY OWNED BY CLAIMANT�IN OTHER COUNTRIES
Counry . TOwnstup Counry Tovrttship
Siqnature of G ' t
���reby certify the above statemenis are We, correct and complete. ��
Addr�(��antl . t,ci fate ZlPOOde) (� � 1 �� �
U!'v� \a
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediatety �� �
surrounding residential improvements. �
Oiherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Oiher improvements (6)
Total improvements (line 4 througA line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, cortect, and Signature of Assesor Date signed
complete.
Verifying action - Signature ot Auditor Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _ . �-
Lesser of 1/2 Homestead y�
aluation or 52.000
SignaNre of Auditor � Date sign ��