Homestead_Sexton�xa eras
CLAIM FOR HOMESTEAD PROPERTY fAX FORM YEAR
'e CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R2 15-92)
INSTRUCTIONS: See reverse side for tiling instructions. $"$1W 1T $n T M
Z
Ia) �W -'e'tk � �.�Jl_C.V'l'C.J cenify. that E5TtFl Z Uaylgarch, 19
)occupied as our principal place of residence the following described real property for which Homestba roperty.Tax Cred hereby Gai ed:
l� I (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 pMq;ty, 006 buying tMirMn ract.
CONTRACT RECORDED
if buying on contram. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION - -
County
Township
Taxing district ity, to n, unship) -
Parcel number
Legal description _
j�
-Co
Address (number and street. city. state. ZIP code) CZA0
If 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.
r
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
®eby certify the above statements are true, correct and complete.
Signature of claimant _ `
' /1/v'r` -/�J\
Address (number and street. city. state. ZIP code) CZA0
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 S2,000
Signature o ndit_orw
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(6)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and -
complete.
Signature of Assessor
Date signed
tying action - Signature of Auditor
c�
Date signed -
STANDARD DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 1/2 Homestead
S
Valuation or S2,000
Signature o ndit_orw
Date signed