HomeMy WebLinkAboutHomestead_RascheCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R2 15-92)
INSTRUCTIONS: See reverse side for filing instructions.
I (We) Lam] ] (,QrQ�`�11L� I�LL.Y certify that_onthe ls�ddl— SIXarch, 19
I (We) occupied as our principal place of residence the following de bed real prop far which a Homestead Pr T Cre reby claimed:
❑ 1 (We) owned ❑ Are buying under contract ❑ Have a beneficial interest in the entity that is liable for the propro erty and that owns thr 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
Taxing district (city, town, township) ,
Parcel number
Op -
Legal description
10501a )lo(alb7
It any portion of the residential structure or the land not exceeding one (1) acre that im &ately surrounds that structure is used to produce income, describe the use and portion
of the properly utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
TRUE TAX
VALUE
Township
County
7ownship
I hereby certify the above statements are true, correct and complete.
Signature of daimant
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)
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 plus line 7)
(g)
�"ertify the above is true, Correct, and
Signature of Assessor
Date 5ignetl
Ver�ction - Signature of Auditor
Date signed
ALLOWANCE
19 _Pay 19_
Lesser of 1/2 Homestead
Valuation or S2.000
Date