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e� ,¢ CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
C • State Form 5473 (R215 -92)
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INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
le) _ (���, —T \ Y /V certify that on the 1st day of March, 19
(We u ied sour principal place of resides he follows , described real pro rt for which a Homestead Property Tax Credit is hereby claimed:
1 (We) owned ❑ Are buying under contract - L��LJ�qq.�'� �IIL�Jq•�I 1F�1
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the proT71�p�[tylisf uy tl�ihd�la ddntract.
CONTRACT RECORDED L°
It buying on contract, Fee Simple owner's name -
Recorder's office where contract is recorded Record m Page
PROPERTY DESCRIPTI N
County ..
Township
Tax" is, ict (city, row .township)
Paid I mber�o O I Q O
Legal description
It any ponion 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.
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED.
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line I plus line 2)
(3)
Residential improvements
(4)
LGa,age'
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
-
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true. correct, and
myirg
Signature of Assessor
Date signed
�plete.
J action - Signature of Auditor
I Date signed
STANDARD
19_Pay 19_
Lesser of 112 Homestead
Valuation or S2,000
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