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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
r State Fonn 5473 (R2 / 5-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
�y CERTIFIC STATEMENT
71(W>e) e) _ certify that on 1t6�t2aJofnah, 19_
pie as our principal place of residence the following described real property for whi omestead Property ax Credit is hereby claimed:
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 pr o N a,cq
AGIBSON AUu
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township-
Taxi is " ry, fawn, I
ship)
Parcel number TT
V
L I description
QJ
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is to produce income, describe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County Township County ITomship
ereby certify the above statements are true, correct and complete.
Sig ure of laimant
Addre mher and street, ci is, ZIP e)
ASSESSOR USE ONLY
TRUETAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (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 plus line 7)
(8)
1 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
Valuation or 52,000
S
Signature of Auditor
Date signed