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a� 4 CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R215 -92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
. - i.cnnrn.r�n�nalsucmcni y3
(We) - — ertify that the 1st d of rch, 19
e) occupied as our principal place residence the following described real property for which a Homestead Pro ' 11eD il aimed,
L i I (We) owned ❑ Are buying under contract - U
❑ 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 owners name
Recorder's office where contract is recorded Record number Page
-
PROPERTY DESCRIPTION -
County ..
Township
County
Taxing district (Gty, tto wnsbip)
P Ip ber oa73 -
Legal description
as
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 property utilized ro produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
- -
County
Township
County
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Township
Valuation or $2,000
�1 ,y certify the above statements are true, correct and complete.
Signatu e of Gaimant
Address (number a //nd11streeL�Gry, slate. mde)
N . I �EU q 7
ASSESSOR USE ONLY -
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL -
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
'
- -
Other land
(2)
Total land (line 1 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 plus line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
irg action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
S
Valuation or $2,000
Signature of Auditor
Date signed = ='
rAl
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