HomeMy WebLinkAboutHomestead_Whitlow4� s.uF o,
` � ; CREDIT/STANDARDTD DUCTI�ON RTY TAX -
�' ��a State Fortn 5473 (R2 / S92)
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16 INSTRUCTIONS: See reverse side lor liling instructions.
FORM
HC10
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YEAR
CERTIFICATION STATEMENT
IVUY (/�j
I(We) .certify that on the 1�day of March, 19_
I(We) occupied as our principal place of residence ihe foliowing described real property for which a Homestead Property Tax 6red,it �is�h(ereby claimed:
❑ I (We) owned ❑ Are buyin9 under contract G�. �, � �' ' ��� �-"",�'� ��
❑ Have a beneficial interest in the eniiry that is Iiabie for the property taues on ihe property and that owns the property or is buying under a contract.
CONTRACT RECORDED
It buying on contract, Fee Simple owners name
Recordefs office where convact is recorded Fiecord number Pa9e
PROPERTY DESCRIPTi '
Coun Tovmship Tazing tli ri ci town, mwnship) �
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Parcel n mber Legal descripuon
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If any portion of Ne resitlential structure or the land noI exceetling one (1) acre that immediately surtounds ihat sVUCture is used to produce income, describe the use and portion of
the property utilized ro produce incrome. �
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry TownShip Counry Township
tu f claimant I
ereby certify the above statements are We, correct and wmplete. � ��—� ,�–�
A ress (numberandstreet, ciry, stafe, ZlPCOtle) .
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ASSESSOR USE ONL TRUE TAX . ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediatety ���
surrounding resideniial improvements.
Other land (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residential improvemenis
Garage , (5)
Oiher improvements (6)
To[a� improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby CeRify Ihe above is tNe, correct, and Signature of Assewr Date signetl
complete_
Veritying acUOn - SignaWre of Auditor Date signed
- STANDARD DEDUC770N ALLOWANCE
19_ Pay 19 _
Lesserof 1/2 Homestead e�
Valuation or 52,000
Signature ot Autliror ` Da[e signcd
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