Homestead_Miller (3)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR'
CREDIT /STANDARD DEDUCTION HC10
•.,�� State Form 5473 (R2/5 92) -
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INSTRUCTIONS: See reverse side for filing instructions. I O
a- G
- - �-
CERTIFICATION STATEEM�E1NI
YKYN „Qp(�L -5„1 ty y AYXO t� certify that on the 1st day of March, 19
�) occupie as ur principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
L] I (We) owned in` 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 c ntract. Fee Simple owner's name
Record e'd Record number Page
- - PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -- -
PROPERTY DESCRIPTION. -- - -_
County -
Township
Township
Taxing gytnpt (city, town. township)
U
Parcel number
Q Li L4
Legal descri tion
If any portion of the residential structure or the land not exceeding
of the property utilized to produce income.
ne (1) acre that immediate y surrounds that structuitQ i used to produce income, describe the use and portion
- - PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -- -
County
Township
County
Township
eby certify the above statements are true, correct and complete.
Signature of claimant "
Address (number and street, city state, ZIP rode) "
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
If k
- -
Otherland
(2)
-- -
ICI Total land (line 1 plus line Z)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
-
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pfrs line 7)
(6)
,
I hereby certify the above is true, correct, and
complete.
Signature of Assessor -
Date signed
�ing action - Signature of Auditor
Date signed
ti
_ -- STANDARD DEDUCTION ALLOWANCE - -
19_ Pay 19_
Lesser of 1/2 Homestead
5
Valuation or $2,000
If k
Signature of Adilpf
Date si ned r,J