Homestead_MooreCLAIM 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.
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- . •, - �; -.. * CERTIFICATION STATEMENT:` il. ' '�` ;.LTY' .: r-i ' � is -fY �f'i .• ".-
I (We) certify that on the 1st day of March, 19
I (We) occupi I s our prin I place of residence the following described real property for which a Homestead Property Ta4deN i$ here5tie qqmed:
I�(We) owned El Are buying under contract /' / a // n
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prope!(Y a,,is_ bpying :6ndeva coot@cl�
CONTRACTRECORDED - .
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION -
County
Township
Taxing district city, town. township) .
Parcel number
Legal description
W
Tess (number and sire state, ZlP code)
S L q6,d 4 l'i k _N do
It 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 to produce income.
4
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
SignaluR of claimant
Tess (number and sire state, ZlP code)
S L q6,d 4 l'i k _N do
_ - STANDARD DEDUCTION ALLOWANCE' -
TRUETAX
ASSESSED
HOMESTEAD
- RESIDENTIAL.'
ASSESSOR USE ONLY
- -
VALUE
VALUE
VALUE
- :NON
VALUE -
Land not exceeding 1 (one) acre immediately
-
surrounding residential improvements.
(1)
- -'
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
r
Residential improvements
- Garage
(g)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plrs line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
_ - STANDARD DEDUCTION ALLOWANCE' -
19_Pay 19_
Lesser of 1/2 Homestead
S
Valuation or $2,000
Signature of Auditor
Date signed ^