HomeMy WebLinkAboutHomestead_Logestan (3)yCLAIM FOR HOMESTEAD PROPERTY TAX
j CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5 -92)
INSTRUCTIONS. See reverse side for filing instructions.
FORM YEAR
HC10
Fit
CERTIFICATION STATEMENT
I ( e) ci to*glor at on the 1 ay of rch 9_
I (We) occupi a ur principal place of resident a following described real property for which a Homeserty Tayc Cr imed:
❑ I (We) owned ❑ Are buying under contract COUNTY AUDITOR ❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns is buying under a contract.
CONTRACT RECORDED _
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number -
Page
PROPERTY DESCRIPTION
County
Township
Taring di s (city, r , township)
Parcel number
no -0o5 16 -
Legal d ption
T fi K -a- `3 3.56
It any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
ereby certify the above statements are true, correct and complete.
Si ature I - nt
Address (number and street, city, state, ZIP code)
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
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 -
complete.
Signature of Assesor
Date signed
Verifying action - Signature of Auditor
Date signed
isSTANDARD
DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
Valuation or $2,0
S
net of Auditor
Oiv
Date signed