Homestead_TravelsteadCLAIM FOR HOMESTEAD
CREDIT /STANDARD DEDUCTION RTY TAX
State Form 5473 (R2 /5-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
YEAR
CERTIFICATION STATEMENT _
I (We) s— / �� S L% certify that on the, —y1 �t d E arch, 19_
I (We) occupied as our principal place of residence the following describ d real property for which a Homestead Property.Tax.,CY cif is hereby claimed:
❑ I (We) owned ❑ Are buying under contract �OQ
❑ Have a beneficial interest in the entity that is liable for the property fazes on the property and that owns the p a�erty or isrb`t$vn� nder a ntr t.
_ CONTRACT RECORDED
It buying on contract, Fee Simple owners name
Recorders office where contract is recorded -
Rdcoidnumber
Page
PROPERTY DESCRIPTION
County
To c
Taxing district (city , town, township)
Parcel n tuber
Legal desorption
It any portion o the resitlen " 1 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
Signatkrp.qf cwm plt
ereby certify the above statements are true, correct and complete.
Address (number and stre city, rate, ZIP code)
Div Y
ASSESSOR USE ONLY
TRUE T
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
VALU
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Otherland
(2)
Total land (line I 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
ser of 1/2 Homestead
S
V 'nor 52,000
Signature of Auditor
Date si netl