Homestead_Williams (25).�L° a
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92)
INSTRUCTIONS: See �everse side /or (ling instructions.
FORM
HC10
YEAR
^� i CERTIFICATION STATEMENT
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1(VJe , certify that on . st a f�1 I1��� (B
I�(We) occupied as our principal place of residence the tollovring described real property for which a Homestead Property Tau Credit is hereby Ciartlleel'i
% I(VJe) owned ❑ Are buying under wnhad J�L ] �UUU
❑ Have a beneficial interest in the enfity ihat is liable for the property taxes on the property and that owns the prope r is buying under a coniract.
CONTRACTRECORDED /�, '
If buying on contract, Fee Simple owners name � �°''"'^"� • ��� -_ OITOR
Recortlers ofFice where contract is recorded Recortl number Page
PROPERTY DESCRIPTION
Counry Township Taxing district (, t , township)
Pa umber Legal tlescription
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If y portion of Ne resitlential struc[ure or ihe land nol exreeding one (1) acre that immediately surtounds ihat sWCture is uud to produce income, descnbe the use and portion of
the Oroperty uLiizetl ro produce income.
- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Townshi shi
Signatur 1 daimam (�
�;ereby certify the above statemen?s are true, correct and complete.� . V„.-. �
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Addre s(nu 6e n s ee ciry, at ZIP cotle) � I ��
� ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDEO L
VALUE VALUE VALUE VALUE
Land not exceeding 1(oneJ acre immediately (� �
sunounding residential 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 (line 3 plus line 7) (8)
I hereby certify the above is true, covect, and Signature of Assesor Dace signed
complete.
Veritying action - Signature ol Audimr Date siqned
STANDARD DEDUCTION ALLOWANCE
� 19_ Pay 19 _
Lesser of 1/2 Homestead S
Valuation or 52,000
Signawre of Autlitor Dat " ed i �
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