HomeMy WebLinkAboutHomestead_BashamFORM YEAR
HC10
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CERTIFICATION STATEMENT - - -
I (We) i�� ti Y41 ®- `U.�.�= "�°Ij �aH certify that on the 1st day of March, 19
?oc led as our pincipal ce of residence the following described real property for estead Property Tax Credit is hereby claimed:
We) owned ❑ Are buying under contract
,3)( ave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED _ It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district (city, town, township)
Parcel number Legal description
e�,(L- bn�
If 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 COUNTIES "
CLAIM FOR HOMESTEAD PROPERTY.TAX
Township
CREDIT /STANDARD DEDUCTION
;yc
State Form 5473 (R2/5-92)
sr.
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
(�
CERTIFICATION STATEMENT - - -
I (We) i�� ti Y41 ®- `U.�.�= "�°Ij �aH certify that on the 1st day of March, 19
?oc led as our pincipal ce of residence the following described real property for estead Property Tax Credit is hereby claimed:
We) owned ❑ Are buying under contract
,3)( ave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED _ It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district (city, town, township)
Parcel number Legal description
e�,(L- bn�
If 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 COUNTIES "
County
Township
County
Township
j§eby certify the above statements are true, correct and complete.
Signal t da,^ nt
Address (number andstreet, ary, state, ZIP code)
a G% 7GG v
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE.,
HOMESTEAD
VALUE
NON - RESIDENTIAL. -
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Signature of Au
ii r
Date signed o
_ _
Other land
(2)
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Total land (line I 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 plrs line 7)
(g)
1 hereby Certify the above is true, correct, and
complete:
Signature of Assessor
Date signed
Verifying anion - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE -
19 Pay 19_
Lesser of 1/2 Homestead
Valuation or $2,000
$
Signature of Au
ii r
Date signed o
_ _
x
(.O l