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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (8215 -92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
Tx k7 t'i )'.I -I'
YEAR
CERTIFI ATION STATEMENT ( IN Ulf ,, �1 -
!, �o
I (We) �� � Q% ° certi aaTTtt opth�nle I�sptt day of March, 19_
1 (We) occupied as our principal place of resi a the following described real property for which a Homestead I eity4JC WNa hereby claimed:
❑ I (We) owned ❑ Are buying un er contract
❑ Have a beneficial interest in the entity that is liable for the property fazes on the property and that owns i!>e{lrop or ism ng a contract.
71, IUD : -
CONTRACT RECORDED
It buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number,
Page
PROPERTY DESCRIPTION
County
Township Taxis tdc , town, wnship
00 3- 6n
Parcel number
Legal de p -
_
If any portion of the residential structure or the lantl n t exceeding'one (1) acre that immeIsu" t struct ure is used to produce income, describe the use and portion of
the property utir¢ed to produce income.
' PROPERTY OWNED BY CL4IMj&AN OTHER COUNTRIES
County
Township
Township
the above statements are true, correct and complete.
gna r re o claimant
eretiy certify
4_�C
Address (numper and street, city, statz ZIP code) �,
3 U /LI_�
ob
ASSESSOR USE ONLY
T UE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Otherland
(2)
Total land (line 1 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, correct, and
Signature of Assesor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
$
Valuation or 52,000
Signature of Auditor
Date signed