Homestead_Creeka% g CLAIM FOR HOMESTEAD PROPERTY TAX
a CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5 -92) .
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INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
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CERTIFICATION STATEMENT:
I (we) certify that on the 1st day q) March, 19
�) occupied as our principal place of residence a following described real property for which a Homestead �perty Tax C.�edit fhereby ai d: -
❑ I (We) owned ❑ Are buying under contract ""�•,TLI', -✓.` 7DITOR r
❑ 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
Cou
Township
Township
T - (city, to , township) _
arcel numb r
Legal 'on
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Other land
(2)
If 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.
Total land (line 1 plus line 2)
(3)
- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES - -
County
Township
County
Township
®eby certify the above statements are true, correct and complete.
Signature of ai nt
Add ss (number and street, city, state, ZIP code)
x 3 0,, - 1d%
- ASSESSOR USE ONLY "
TRUE TAX
- VALUE,.
ASSESSED
VALUE,.
HOMESTEAD
VALUE -
NON-RESIDENTIAL,
- VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
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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)
(g)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
I Date signed
Verifying action - Signature of Auditor
Date signed
- - - STANDARD DEDUCTION ALLOWANCE
19 Pay 19
Lesser of 1/2 Homestead
Valuation or $2,000'
S
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Date signed !
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