HomeMy WebLinkAboutHomestead_Keasling(iE [T`rf
a .r CLAIM FOR HOMESTEAD PROPERTY TAX
x�! CREDIT /STANDARD DEDUCTION
State Form 5473 (112 / 5 -92)
rug
FORM YEAR
HC10
INSTRUCTIONS: See reverse side for filing instructions. -
5
ERTIFIcAnO TATEMENT
0
�Na) _ / certify that on the 1st day of March, 19
a) oc ied as our principal plac� off ()e an .following described real property for ich a Homestead Property Tax Credit is hereby Gaimed:
E3 I (We) owned ❑ Are blJ)n0' unC, coot, _��
❑ 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
It buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
" PROPERTY DESCRIPTION
County Township
Oreby certify the above statements are true, correct and complete.
County
Address (number and street. city, state. ZIP code)
Township
Taxin i trict (-
n, towns
Parcel number
al e iption >
/
It any portion of the residential structure or the land not exceeding one (1) acre that i ediately surroun s 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
Oreby certify the above statements are true, correct and complete.
County Township
Signature of claimant
Address (number and street. city, state. ZIP code)
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL.
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
-
Otherland
(2)
Signature of Auditor Date signed
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 pl/s line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
ring action - Signature of Auditor
Date signed
" STANDARD DEDUCTION ALLOWANCE
19_ Pay 19_
Lesser of 112 Homestead
S
Valuation or 52,000
Signature of Auditor Date signed