Homestead_BruceCLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 (R5110 -01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
In 7 1 - / / CERTIFICAT) q N STATEMENT:f T
(We)—A L lirizf \,L 1\-V-lf
.1Zj-tA-,t-l1 -AL A44 diLW t_qkjPay of March, 20
(We) occupied r as our Vdncipal Face of residence the following described real property for which a lead Pro any Tax Credit is hereby claimed
❑ I (We) owned ❑ Are buying under contract luff 3 1 Y1002
Have a beneficial interest in the entity that is liable for the property taxes on the property bpd that owns t e , 70erty or is buy g under a contract.
1
CONTRACT' RECORDED
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded
Record number I Page
'-OFiOPEkTY�bWNE6BY CLAIMANT INOTHER - COUNTIES `<�1*--:
-PROPERTY DESCRIP TION
Township
zbpqm�
Tovnsh ip
1 4
A
Taxing dist
1 7/`
t n�t wnsyhip
7 qmZ4
4me pu
!t`§ztL'�"--�'VALLUE" -,?(z
I
Is the
grope y ii�- question:
U
(I
Sigr,ro of Audit r
❑ Real property ❑ Mob Ct.
If any portion of the residential structure or the Land not exceeding one
of the property utilized to produce income.
(1) acre that immediately sumo, -nds
that structure is used to produce Income, describe the use and portion
surrounding residential improvements.
7
'-OFiOPEkTY�bWNE6BY CLAIMANT INOTHER - COUNTIES `<�1*--:
County
Township
County
Township
I hereby certify the above statements are twe, correct and complete.
Signature of claimant
Gress (number and street, city, state, ZIP code)
t
'TRUE-TAX
ASSESSED VALUE
---HOMESTEAD -
j ' NON-RESIDENTIAL-` `,��
ASSESSOR USE ONLY !,
.VALUE
AT.1pq%OF-TTV,�.
VALUEft!
!t`§ztL'�"--�'VALLUE" -,?(z
I Valuation or $6,000
Sigr,ro of Audit r
Land not exceeding I (one) acre immediately
Date
rc -,3
surrounding residential improvements.
7
Other land
(2)
Total land (line I plus fine 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
TANDARDMEDUCTICIN ALLOWANCE
20 _ Pay 20
Lesser of 112 Homestead
S
I Valuation or $6,000
Sigr,ro of Audit r
Date
rc -,3