HomeMy WebLinkAboutHomestead_Simpson (2)CLAIM FOR HOMESTEAD PROPERTY TAX
° CREDIT /STANDARD DEDUCTION
State Forth 5473 (R2 / 5-92)
INSTRUCTIONS: See reverse side for filing instructions.
rAAL
FORM
HC10
NO e' I a1
YEAR
_) A CERTIFICATION STATEMENT _
9
VV / 1
I (we) cehlfyMMAA't Ariihr Wbay of March, 19_
I (We) occupied as our princi al place of residence thJ following described real property for which a Ho ead Pn3pe T redit 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 property and tha owr�9lm MOy1Lt y e a contract.
CONTRACT RECORDED
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)
EArcel
umber
Legal descripWA
n
Many 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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township County
Township
Sig t of imam
. , ereby certify the above statements are true, correct and complete.
Ad ress (number 7pd sI t, city , st ZIP code) O IF
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 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)
1 hereby certify the above is true, correct, and
complete.
Signature of Assesor
Date signed
Venlyng action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
Valuation or $2,000
$
Signature of Auditor
W
Date si ned
-o