HomeMy WebLinkAboutHomestead_BenderCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Foan 5473 (R215-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
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CERTIFICATION STATEMENT N'
1 (We) QAQ U41hA certify that on the 1 tt day of Mar 1g_
I (We) occupied as our principal place of residence the following described real property for which a Homest a Property T O Qdlt is h by imed:
❑ I (We) owned ❑ Are buying under contract tiv� ?;) 4 TOR
❑ 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.
CONTRACT RECORDED
It burying on contract, Fee Simple owners name
Recorders office where contract is recorded -
Record number
Page
PROPERTY DESCRIPTION
Township
Taring dist' . t m. s )
Par I n mber
r o - oa ao
Legal descri 1
If any portion of me residential structure or the land not exceeding on (1) ore that immediately surrounds that structure is used to produce - e, describe the use and portion of
the property ubtized to produce income.
CX /r00 ,24,
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
certify the above statements are true, correct and complete.
Sig + re of claimant
-
Address (number an (reel, city, state. ZIP code) n
J 13 0 /f 3 i:c,
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 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 plus line 7)
(S)
I hereby certify the above is true, correct, and
complete.
Signature of Assesor
Date signed
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
-19_ Pay 19_
Lesser of 1/2 Homestead
V ation or $2,000
3
S n e of Audito
Date sign — / 8 — O o