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e� °, CLAIM FOR HOMESTEAD PROPERTY TAX
. CREDITISTANDARD DEDUGTION
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�' State Form 5473 (R2 / 5-92)
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WSTRUCTIONS: See reverse side /or filing instructions.
FORM YEAR
HC10
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I�We) _���� �� hJ �� . � certif�at on Ihe 1 d f Marc 19
�) occupied as our principal place ot residence the following described real property for which a Homestead�Ptoperty� I" ed:
� . . �;-..a;.;:;;q?'7 �ii;)!TOR
❑ I (We) owned ❑ Are buying under coniract _ . • , � �
❑ Have a beneficial interest in the entiry ihat is liable for ihe property taxes on the property and that owns the property or is�buying under a contract.
� � - � � CONTRACT RECORDED . � � - � ��
It buying on coniract. Fee Simple owneYS name
Recorder's oMice where contract is recordetl Record number Page
r. �
' - PROPERTY DESCRIPTION � � '
Coun�� . . Towr�ship Taxing district (ciry, fown, fownship) �
�n '
Parcel number Legal de
OS - 3a/-O � - - - /d �oAc
tl any portion of Ihe resitlential stmcture or Ihe land not exceeding one (t) acre that immetliatety surrounds that structure is used to produce income. tlescribe the use arW portion
of ihe property utilizetl ro protluce income. _
ASSESSOR USE ONLY , TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL'
� VALUE VALUE.- VALUE VAIUE
Land noi exceedin9 7(one) acre immediately
surroundingresidentialimprovemenis. (�) ��
Otherland (2)
Total land (line 1 plus line Z� (3)
Dwelling (4)
Resideniial improvements
� Garage � (5� � .
Oiher improvements (6)
Total improvements (line 4 through line � (7) (
Total value (line 3 p�s line � (8) I
I hereby certity ihe above is irue, COrreci, and Signature ot Assessor Date signetl
complete. •
v^�Fyifg action - Sgnamre of Auditor Date siqnetl
� � STANDARD DEDUCTION ALLOWANCE �
I19_Pay19_ .
Lesser of 1/2 Homestead
Valuation or 52.000 5
Sgn ure f AuGimr Date siglr ed � �
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