HomeMy WebLinkAboutHomestead_WillisCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R21 5-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
YEAR
• CERTIFICATION STATEMENT n(1�
(We) t�&1 t day of March, 19_
I (We) occupied as our principal place of residence the following described real property for which a Ho �stead Propert011,r�emqe ' by claimed:
❑ 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 ( 8 r �q(pjjQa cont ract.
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION '
County
Township
Taking district
P roye purr C)016 / _0` U
Legaldescription
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 potion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township _
-
County
r
Township
eMSig
reby certify the above statements are true, correct and complete.
a i
A dre number and street ry, state, IP code) '
`f ( G%lo
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSE
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
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
Valuation or $2,000
S
Si at
a of
itor
Date 5 ed
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