Homestead_Douglas�.a!*��R
a�/ " g CLAIM FOR HOMESTEAD PROPERTY TAX
i��'= CREDIT/STANDARD DEDUCTION
���� Staie Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side lor liling inslructions.
v
FORM
HC10
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YEAR
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��We) �,d,y.u.� iYi �i�- x�p..�r, V� /}� certifyahat on ihe 7si�dayeoE�March�t9�
.?) occupied as our principal place of residence the followi�escribed r I property for which a Homesiead Property Tax Credit is hIe�.reby claimed:
U I(We) owned ❑ Are buyin9 under contract _ /� p �yW�.y'S
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❑ Have a beneficial interesi in the entity ihat is liable tor the property taxes on the property and ihat owns ihe property or is buying under a contract.
- � CONTRACT RECORDED ' �
II buying on contract, Fee Simple owner's name
Recorder's ottice where coniraci is recorded Record number Page
Counry
° � PROPERTY DESCRIPTION �
7ownship . Taxing distria (ciry, town. lownship)
Parcel number Legal description ��� � ' � �
oos-oo�aa-oo
It any ponion of the resitlential strucmre or the lantl not exceeding one (7) acre that immediately surrounds �hat structure is usetl to protluce income, deudbe ihe use and ponion
of t�e property utilized to produce income. .
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TownShip
— ���
OWNED BY�CLAIMANT IN OTHER COUNTIES
Caunty
.��by certify the above statements are tme, correci and complete.
Address (number and slreet, ciry. stafe, ZIP code)
ASSESSOR USE ONLY TRUE TAX
VALUE
Land not exceeding 1(one) acre immediately
surrounding resideniial improvements. (�)
Otherland (z)
Total land (line 7 plus line Z�
Residential improvements
Oiher improvements
(3)
Dwelling (4)
Garage (5�
(6)
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line 7) (g)
1 hereby certify the above is lrue, torreCi. and Signature of Assessor
camplete.
��'virg action - Si9namre of Auditor
Signature
ASSESSED I HOMESTEAD
VALUE VALUE
NON-RESIDENTIAL
VALUE
Dale signed
Date signed
0
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