Homestead_HartsburgCLAIM FOR HOMESTEAD PROPERTY TAX
i CREDIT /STANDARD DEDUCTION
> State Form 5473 (R2/5-92)
r INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
FWA
CERTIFICATION STATEMENT
1 (We) S c ify at n e t t March, 19_
1 (We) occupied as our principal place sidence the following described real property for which a H stea ro. .Tax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract DEC 27 2000
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or i buying under contract.
CONTRACT RECORDED Y At aTOR
If buying on conbact, Fee Simple owner's name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
52 P
Ccu
Townsh'
Taxing tlistrict " , Town ownship)
L
Part /el umber�,1 -�
Legal description
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that stmaure 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 natur f imdni
dress (number and street, city, state. ZIP code)
ASSESSOR USE ONLY
TRUE T X
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
Dale signed
complete.
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
L ss of 1/2 Homestead
5
,i
V luau or $2,000
Signature of Auditor /
Date signed
FWA