HomeMy WebLinkAboutHomestead_TooleyCLAIM FOR HOMESTEAD PROPERTY TAX
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CREDIT /STANDARD DEDUCTION
.., Sate Form 5473 (R2/5-92)
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INSTRUCTIONS: See reverse side for filing instructions.
as our principal place of regfd6nce the
FORM YEAR
HC10
certify that on I
for which a Homestead Property
• ](We) owned ❑ Are buying under contract - V INov ,� 1p_I
• Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the properly gr is buying under A 69 r`act.
RECORDED
It buying on contracr. Fee Simple owner's name
Record number I Page
PROPERTY DESCRIPTIO
County
Township
Taxing distri i ton , t wnshi '
NON- RESIDENTIAL
VALUE
Legal description
It 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 properly utilized to produce income.
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(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)
I hereby cenify the above is true, correct, and
1plete.
Signature of Assessor
Date signed
Dying action - Signature of Auditor
Date signetl _
19 _Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
V
STANDARD DEDUCTION
S