HomeMy WebLinkAboutHomestead_Benjamine °q CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
'= CREDIT /STANDARD DEDUCTION HC10
..,, State Form 5473 (132 / 5 -92)
•ia
INSTRUCTIONS: See reverse side for filing instructions.
' "Ne) _V�,� /�«± d. - _ _ —cc..i certi that on the 1st of r 1
�3) occupied as our principal place of r id a the fol'awing dd�es�cribeed real property for which a HomesieaPy x ItSs here y imed:
❑ l(We)owned ❑ Are buying u e r !��� AUDITOR
❑ Have a beneficial interest in the entity that is lia for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED
If buying on contract. Fee Simple owner's name -
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township)
Parcel number
i e - 19-0o
Legal description
a
If any portion of the residential structure or the land not exceeding one (1) aae that immediately surrounds that Anucture is used to frodu6e income, describe the use and portion
of the property utilized to produce income. .
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
Weby certify the above statements are true, correct and complete.
Signal a of claimant
Address (number and street, aty, state, ZIP code)
0 8 VV /h
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE '
Land not exceeding I (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Signature of Auditor D Date signed —
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)
(6)
I hereby certify the above is true, correct. and
complete.
Signature of Assessor
I Date signed
'tying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
S
Valuation or $2,000
Signature of Auditor D Date signed —