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e 4 CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
..;,'• • State Form 5273 (R2/5-92)
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INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
-
TIFICATION STATEMENT -
_
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certify that on the 1st day of March, 19
o cupi as our principal place of residence th
owing described 7e r perty for which aHomestead Property Tax Credit is hereby claimed:
r' 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.
Legal description
-3
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.
�G- 17 o W /. /s9 -461
HOMESTEAD -
VALUE
NON-RESIDENTIAL
VALUE
Land not exceeding t (one) acre immediately
surrounding residential improvements.
(1)
-
CONTRACT RECORDED -
-
-.
(2)
If buying on contract, Fee Simple owner's name
0 1994
MAY 10
Recorders office where contract is recorded
Total land (line 1 plus line 2)
Record number mb i. y)
Page
A7 0/
ZS
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PROPERTY DESCRIPTI N -
County
Township
Taxing dis i
t
Addr ss (n
( r I number
I
^ O
Legal description
-3
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.
�G- 17 o W /. /s9 -461
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township _
by certify the above statements are true, correct and complete.
Si re t
I mant
Addr ss (n
er and beef. ufy slpte. ZIP ) q
ASSESSOR USE ONLY
TR U�ETTAX
VALUE
ASSESSED
VALUE
HOMESTEAD -
VALUE
NON-RESIDENTIAL
VALUE
Land not exceeding t (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 pf7e line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Vng action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 1/2 Homestead
S
Valuation or $2.000
Signature of Auditor 9`�—
Date tl O
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