Homestead_Durane�`%�"�`° CLAIM FOR HOMESTEAD PROPERTY TAX
! ,, CREDIT/STANDARD DEDUCTION
�e State Fortn 5473 (R2 / 5-92) -
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INSTRUCTIONS: See �everse side lor /iling instructions.
FORM
HC10
YEAR
g9 ao
`� CERTIFICATION STATEMENT � • �
I(VJe) .� )u.R R nJ 1�/'o l9 /%� � C��-(�� L certiry that on the 7 st day of March, 19_
I(We cupied as our pnncipal place of residen e the following described real property for which a Homestead Properry Tax Credit is hereby claimed:
I(We) owned ❑ Are buying under conhact � �
❑ Have a beneficial interest in the entity that is liable for the property tazes on the property and thai owns the property or is buying under a contract.
�� CONTPACTRECORDED �
If buying on contract, Fee Simple ownefs name
Recordels office where contract is recortletl - Record number Page
PROPERTY DESCRIPTION -
Counry Township � - Taxing district (ciry, rown, fownship)
I''l� n1T,
Parcel number Legal descnption
pos -oyo(�s-oo Pt c.� s � /�-3-/a �{ �c.
If any portion ot ihe residential striiclure or the land not exceediry one (1) acre thai immediatety surtounds that sVUC[ure is uud to produce income, describe the use and portion of
ihe properry uGlized to produce income.
- / /�- - �.`OG�- 0�/
PROPERTY OWNED BV CLAIMANTiN OTHER COUNTRIES
Counry Tovmship Counry Township
SignaNre of claimant .
,� reby certify the above statements are true, corred and complete. .
Atltlress (numbe�andstreet, city, state, ZlPCOtle)
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding 1(one) acre immediately (�)
surrounding resideniial improvements.
Otherland (2)
Total land (line 7 plus line 2J (3)
Dwelling (4)
Residential improvements
Garage (5)
Oiher improvemenis (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is tme, correct, and Signature ot Pssesor Date signed
complete.
Verifying aciion - Signamre of Autlitor Date signed
i STANDARD DEDUCTION ALLOWANCE �
79 Pay 19 _
� Lesser of 1/2 Homestead S
Valuation or 52.000
SignaNre o( Audilor Date signed '