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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / 592)
INSTRUCTIONS: See reverse side !or tiling instructions.
FORM
HC10
YEAR
� CERTIPICATION STATEMENT
I(VJe) c th e st ay of March, 19_
I(We) occupied as our principal place of r sidence the follovring described real property for which a Homestead Prope�x 6r�lit�eby claimed:
� e) owned ❑ Are buying under contract U l� 1 J
❑ Have a beneficial interesi in the en6ty that is liable for the properry [axes on the property and ihat owns the r perty or is b yin der a ntr
CONTRACTRECORDED
I( buying on contrad, Fee Simple owners name -
Recortlers oifice where mntract is recorded - Fecord number Page
PROPERTY DESCRIPTION
Counry Townsttip Tarinq district ' , township) '
Parcel num� Leqal tlescnp6on
O -0 36���
If any ponion oi the residential strucWre or the land not exceeding one (1) acre that immediatety sunountls Nat structure is usetl to protluce income, describe ihe use and poNOn of
Ne properry utilize0 m produce incame.
07�0 -��030- OU - � �'�C� - Oo�/
PROPERTV OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Coun Tovmshi
Sig in�ur_e of daimam
ereby certify the above statements are true, correct and complete. l� //
(.(i�a�h,
Atldress (number arrd street, ary, stafe, ZIP oode� �
0 9 Ow�nsv��!!e h S/�6G5
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding t(one) acre immediatety (� �
surrounding residential improvemenis.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (a) �
Residential improvements
Garage (5)
Other imprwements (6)
Total improvements (line 4 thiough line 6J (7)
Total value (line 3 plus line 7) (8)
1 hereby ceRify the above is true, Correct, and Signature of Assewr Date signetl
complete.
Verifyinq action - Sgnature ot Autlimr Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
Valuation or S2,000
SignaWre of Auditor Date signed