Homestead_Blankenbergereye R CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
s' CREDIT /STANDARD- DEDUCTION HC10
State Form 5473 (R2 / 5 -92)
INSTRUCTIONS: See reverse side for filing instructions.
-- CERTIFICATION STATEMENT _ d --I 1Q .S
1 (We) / certify that on the 1st day Mar 19
t) occu ied as our principal place of residence the toll 1 in escribed real property for which omestead P etop rty TyyC Tt y claimed--
Li I (We) owned ❑ Are buying under contract Eiuo�
❑ 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 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
- TW -oo
Legal description
. - .- �-3 =l1 •OD
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. -
VALUE
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
certify the above statements are true, correct and complete.
Signature claimant It!
ddress (number and street, city, state, ZIP code)
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON -RESIDENTIAL
-
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
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
Signature of Assessor
Date signed
complete.
"yipg anion - Signature of Auditor
Date signed
19_Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
DEDUCTION ALLOWANCE
I