HomeMy WebLinkAboutHomestead_WoolseyCLAIM FOR HOMESTEAD PROPERTY TAX
s CREDIT /STANDARD DEDUCTION
�• State Farm 5473 (R2 / 5 -92)
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INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
YEAR
RTIFICATION ST EMENT
I (We) certi at o a , _
I (We) led as our principal place of residence the f flowing described real property for which a Homestead Property WrP�it is t705@i7y claimed:
I (We) owned ❑ Are buying under contract I"I/�j [�U
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pro rty or is buyi u r a con ct.
CONTRACT RECORDED GIBSON CUUN I y Auul I '
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township
Taxing district (tlxtowre r s
( \`J\
PO
1ger, ^ 3_
Legal description
Cj
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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County Township County
Signature of claimant
ereby certify the above statements are true, correct and complete.
Address (nu I, airy srafe, ZlPcod
\BUJ \SE
ASSESSOR ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HO E
TEAD
UE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(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)
(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
Signature of Auditor