Homestead_GatesCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/5-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
"CERTIFICATION STATEMENT
I (We) cr that on the 1sl.day of March, 19
1' Fg 6.1 1*1 1 I
I (We) occupied as our principal place of residence the following described real property for which a Homes[�ea P�peyrty� Gcedit is�hereby claimed:
l(We)owned ❑ Are buying under contract 1��Q
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns th ftpertyror iig under a contract.
A
-> - '.CONTRACT RECORDED_ It buying on contract. Fee Simple owner's name /D �)B$Q'•
Recorder's office where contract is recorded Record number Page
_
'
- PROPERTY DESCRIPTION
.. -- .
. � - '
Cou
Township
County Township
Taxing fi6qk1 (
t n, towns p) n /
ParceLn� pr Ox -C.�.7 /
Legal tlescription
*
(2)
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 properly utilized to produce income.
1
- ASSESSOR USE ONLY -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
HOMESTEAD
VALUE
Township
County Township
I hereby certify the above statements are true, correct and complete.
Sign of cla ant
Iress (�mber an street, riry,
ate. ZIP code)
��
1
- ASSESSOR USE ONLY -
TRUETAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
111
-
Other land
(2)
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 pDs line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD
19 Pay 19_
Lesser of 1/2 Homestead
Valuation or $2,000
5