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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R2 / 5 -92)
INSTRUCTIONS: See reverse side for riling instructions.
FORM AR
HC10
CERTIFICATION STATEMENT -
I (We) certify that on the 1st day of March, 19
Lpied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby 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 owns the property or is buying under a contract. .
Si nature of clai ant
Taxing district (d
CONTRACT RECORDED `
Parcel nlLmber-
If buying on contract. Fee Simple owner's name
MAY 10 199:;
Recorder's office where contract is recorded
Rec number
Page
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 property utilized to produce income.
/o��d/ y
-1,11 A-
Total land (line I plus line 2)
ramnr to] c&
- "
PROPERTY DESCRIPTION
County
County
Township
Si nature of clai ant
Taxing district (d
n, w hip)
Parcel nlLmber-
Legal description
Otherland
/
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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 property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township
County
Township
:eby certify the above statements are true, correct and complete.
Si nature of clai ant
Address (number and street, dry. state. ZIP code)
,E? /Z. Xt� Bo - .33 /
,, y76 9
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL..
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Signature of Auditor
Dale aimed
3
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 phs line 7)
(g)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
j
ifying action - Signature of Auditor
t
I Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
$ '
Signature of Auditor
Dale aimed
3
i6.