Homestead_RickettsCLAIM FOR HOMESTEAD PROPERTY TAX
i CREDIT /STANDARD DEDUCTION
J i• State Form 5473 (R215-92)
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1 1fi
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
YEAR
®CIR15FAIII STATEMENT
I (We) certify that on the 1 st day of March, 19_
I (We) led as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
(We) owned ❑ 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.�s buyi�ing under a contract.
CONTRACT RECORDED
It buying on contract, Fee Simple owners name My I U UU
Recorders office where contract is recorded
Record numb?,
ag
PROPERTY DESCRIPTI / �..'- -: ^?.I _.== " -' -'.a tUr• f
County
Township
Taxing dis (city, wn, fo n ip)
1
rc I�mb
�, 3 S
ascription
It any portion of the residential structure or the Land not exceedng 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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES '
C my ITownship Icounty i
Sig re fclaimant
Hereby certify the above statements are true, correct and complete. 7+�n
ddress (number antl freer, city, st e, ZIP code)
3 27)6!�
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
(1)
-
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
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
Signature of Assesor
Date signed
complete.
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
$
Valuation or $2,000
Signature of Auditor
Datened
S U - e7