Homestead_BrightCLAIM FOR HOMESTEAD PROPERTY TAX
i� CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/5-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
�We ) / ( /G certify that on the � �Istst ppday of March, 19
Je) occupied ur principal place of res nce the following described real property for which a Homesteadrftppdrrtj0Ta N%it is hereby claimed:
I 11``11 �V ��
❑ 1 (We) owne ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that ov r)s the pra,9940 i ij contract.
-. CONTRACTRECORDED_ 1 "' -r...� `
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
' - PROPERTY DESCRIPTION, - - - -
County
County
Towns
Taxing dist town, wnship)
S/
Addre u r and street, aty, state, ZIPOOde1
VALUE
VALUE.
Pa el number
Legal description
0
If
If any potion of the resitlential stru
film 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.
-
Otherland
(2)
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
areby certify the above statements are true, correct and complete-
natute ff= aimant r -
Addre u r and street, aty, state, ZIPOOde1
VALUE
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 1 plus line Z)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pbs line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
,•ymg action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE"'.-
19_Pay 19_
Lesser of 1/2 Homestead
$
Valuation or $2,000
Sgna Autlit Date signed _