Homestead_Creedons..,F
a „ CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (132 15-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
YEAR
GERTIFIGATILIN STATEMENT
IIi'1 1 r
I (We) certify that 6"h1he 1st day of March, 19
1 (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract -
❑ 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)
Parcel number
D l
Legal description
n
I
16 - La -log-'N
24
If any portion of the residential structure or the land not exceedi g one (1) acre that immediately surrounds that structure is used to produce income, descnbe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
TownshipCounty
Township
e c claimant
�.reby certify the above statements are true, correct and complete.
d ress (number and street. city, state, ZIP code)
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
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)
1 hereby certify the above is true, correct, and
Signature of Assesor
Date signed
complete.
—rate
Verifying action - Signature of Auditor
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead 8
Vpluation or $2,000
/
Signature of Auditor
I l
�j
Dat /e�si�gned I /� - O
/ y1