HomeMy WebLinkAboutHomestead_Davis (12)11
s * +rE4 CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
rh Sate Form 5473 (R2l 5-92)
16
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
YEAR
CERTI ATION STATEMENT
I (We) — certify that on the 1st day of March, 19
I (We upled as r for ipal place of residence following described real property for which a Homestead Prop redit is lamed:
th�e4�aby
1 (We) owned ❑ Are buying under contract j f %r 'a
❑ 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 ontract.
MAY
CONTRACT RECORDED j
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
lIn e
PROPERTY DESCRIPTION
County -_
Township
Taxing
s
ty town, lown hip)
a nprtrbe�
Legal de
r hon
ing e (1) acre t immediately surrounds that s ucture is us
i ed to pm&ree income, describe the use and potion of
If any portion of the residential structure or the land not ex on
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County Township - - Township - I
Signature of claimant
®ereby certify the above statements are true, correct and complete.
Address (number and sweet. city, sate. ZIP code)
oX`l9b O�e'n6vt Ll_G ltd
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON-RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Otherland
(2)
Total land (line 1 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)
(8)
1 hereby certify the above is true, correct, and
Signature of Assesor
Date signed
complete.
Verifying action - Signature of Auditor
tD.t.signed
STANDARD DEDUCTION
ALLOWANCE
19_ Pay 19
Lesser of 1/2 Ho estead
S
Valuation or ,000
Signature of Auditor