HomeMy WebLinkAboutHomestead_NicholsCLAIM FOR HOMESTEAD PROPERTY TAX
j° CREDIT /STANDARD DEDUCTION
> ' State Form 5473 (R2 15-92)
6
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
"T� R-%�
YEAR
CERTIFICATION STATE T
11-1 '. _
I (We) on the 1 st day of March, 19_
I (We) occupied as our principal place of residence the following described real property for which a o s Tax Credit is hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the prope "hat e perry s b ing under a contract.
GIOSON 3 AUorr R
CONTRACT RECORDED
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township Taxing
district (dry, town, township)
Parcel number
Legal description
/
If any portion o e residential structure or the Land not exceeding one (1) ac that immediately surt 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 COUNTRIES
County
Township
County
Township
�ereby certify the above statements are true, correct and complete.
ig tur claimant L
re
Add (number and et. dry, st fe, ZIP code)
ASSESSOR USE ONLY
TRUE T
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(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)
(8)
I hereby certify the above is true, correct, and
complete.
Signature of Assesor
Date signed -
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
Valuation or 52,000
S
Signature of Auditor
Date signed