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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
SWte Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side /or (ling inshuctions.
FORM
HC10
YEAR
RTIFICATION STATEMENT �
I(We) ` ` certify that on the 1 st day of March, 19_
I(We) occupie as our inci al place of residence ihe following descri eal property for which a Homestead Property Tax Credit is hereby claimed:
I(We) owned Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the properry and that owns ihe property or is buying under a contract.
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CONTRACT RECORDED � .;:, � , b .• �
It buying on contract, Fee Simple ownefs name ���'� -�`^9
r�r �
Recordefs office where contran is recortletl Reco umber
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PROPERTY DESCRIPTION � �
Counry Tovms�ip Taxingdisirict ( fo .�rownsTiP) - -'-: �-�.;U;:Ty
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r mb Legaldescnption
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If any portion of the residentlal strutlure or Ne lantl noi exceeding one (1) acre Ihat immediately surtounds Ihat sUUCture is used to produce income, describe the use and portion of
the pmperry uLlized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Township
Signat daiman�
iereby certity the above statements are true, correct and complete. �
� Address (number arW street, ci sla(e, ZIP code) �
e �r...�- � O �Y K �6 �
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDEM'IAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (� � -
surrounding residential improvements.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residentiat 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 ihe above is true, correct, and Signature ot Assewr oate signed
complete.
Verifying action - Siqnature of Auditor Date signed
. STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead �
Valu tion r 52,000
Sgrumre of Autlitor Dat igned ^�
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