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arx�CLAIM FOR HOMESTEAD PROPERTY TAX
. CREDIT /STANDARD DEDUCTION
State Form 5477 (R215 -e2)
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INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
_,- CEHTIFiCAT10N STATLMENT'-
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I (We) certify that on the 14XIi /of`Marcft}g9tT
I (We) occupied as our principal place of residence a ollowing described real property for which a Homestead Property Credit is hereb laimed:
❑ 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 that owns the propertyoris-buying under 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
Tqxmg di trip (aty, town, township)
Parcel number
601 -66
Legal description
If arty portion of the residential structure or the land not exceeding one (t) re that immediately surrounds that structure is used to produce inco e, describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
�ty Township County Township
TRUE TAX
VALUE
I hereby certify the above statements are true, correct and complete.
Signature of claimant
Address (number and street, city, state, ZIP code)
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 pbs line 7)
(6)
reby certify the above is true, correct, and
mplete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE` 19_Pay19
Lesser of 112 Homestead
$
Valuation or $2,000
Signature of Auditor to gned
_� I