Homestead_Berryman�CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
I State Form 5473 (82/5-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10�
CERTIFICATION STATEMENT
FEB 1 !
1 (We) nptt-q—, /certify that on the 1 s day of March, 19_
I (We) occupied as our principal place of residence the o owing describ eal property for which a Homestead Property Tax Credit ishereby claimed:
❑ I (We) owned Are buying under contract G16SON C*C� .'1fTY AUDITC9 1
❑ Have 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
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township)
a r�ber , _ —
_theeJresidential
Legal description
If any portion of structure or the land not exceeding one (1) ace that immediately surrounds that structu used to produce' come, describe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
Signatu of claiman
ereby certify the above statements are true, correct and complete.
'
Ad e s (number and street, city, state, ZIP code) U U '
ASS SOR USE ONLY
TRUE AX
ASSESSED'
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Other land
(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)
1 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 - S
Valuation or S2,000
Signature of Auditor
Date igned
I