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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Fortn 5473 (R2 / S92)
INSTRUCTIONS: See revefse side for filing insnuctions.
FORM
HC10
YEAR
ERTIFICATION STATEMENT
�(WQ) c th t f , 19_
I(We) occupie our principal place of resi ence the following described real property for which a Homestead Prop r i eby claimed:
❑ I (We) owned • ��� � ��
❑ Are buying under contraot
❑ Have a beneficial interest in the entity thaUis liable (or the property taxes on the property and Nai owns the perty or is nder a ntr at.
� CONTRACTRECORDED
If buying on conVad. Fee Simple ownels name
Recortlers office where contract is recorded - Record number Page �
PROPERTY DESCRIPTI
County Township -� Taxing isln ci wn. township) '
Parcel number Legal descnption
D /� - q � � /S� S
If any poNOn of the residential strudure or Ne lantl not ezceeding one (7 ) acre thal immediatety su unds th rucNre Is usea to produce i�o e, describe ihe use arW portion of
Ne property utilized to pioduce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry - Township
S mre of daimant
ereby certify the above statements are true, correct and complete. '
A tlre number and street, ciry, sfete, Z/P code) -
n.i L t`- �., o.., �i a- )
ASSESSOR USE ONLY TFUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE � VALUE VALUE VALUE
Land not exceeding i(oneJ acreimmediately (��
surrounding residential improvemenis.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4) -
Residential improvements
� Garage (5)
Other improvements (6)
Total improvemenis (line 4 through line 6J (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, correct, and Signature of Assesor Da�e signea
wmplete.
Verifying action - Signature of Autlimr Dare signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
aluation or 52,000
Sig aW otAUdit Date$g� �^'O�
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