HomeMy WebLinkAboutHomestead_Hurt�Y.E [!`��F
e�/ �; CLAIM FOR HOMESTEAD PROPERTY TAX
i���: CREDIT/STANDARD DEDUCTION
.�:,��� State Form 5473 (R2 / 5-92)
�e�.
INSTRUCTIONS: See reverse side lor liling instructions.
�
FORM YEAR
HC10
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I(We) �_ Q'1' �` certify. that on ihe 1 st day of March, 19_
I(We) occupied as our principal place of reside e the following described r al property tor which a Homestead Property T� �d�t'�e�by �-J
�t (We) owned ❑ Are buying under contract _ AUDITO�
Have a beneficial inierest in the entity that is liable for the property taxes on the property and ihat owns the property or is buying under a contract.
� � �� CONTRACT RECORDED ' � �
It Wying on wntract, Fee Simple owner's name �
Recortler's oHiCe where mntraCi i5 recorded ReCOrd number Page
Cqunry
TownShip
town,
Parcel num6er � Legal tlescription \ O J
eo �s'' o3$)S• DI�
II any ponion of the residential stmcture or ihe land not exceeding one (1) aue that immediatety surrounds that swciure is used ro produce income, tl�
ot Ihe pwperry u6iized ro produce income.
c��-/7-O/-�OG-003. �/� 0.1/
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Coun�y Township Counry Township
I hereby certify the above statements are irue, correci and complete.
ess (number and street, ciry, siate, ZIP wde)
Co� 7� z �� -�'�
ASSESSOR USE ONLY - � TRUE TAX
VALUE'
Land not exceeding 7(one) acre immediately
surrounding residential improvemenis. (�)
Otherland
Total land (line 7 plus line Z)
Residential improvements
Oiher improvements
lz)
(3)
Dwelling (4)
Garage (5)
(6)
Total improvements (line 4 through line �
Total value (line 3 p�s line �
I hereby certify the above is true, correct, and
wmplete.
Verifvirw action - Siana[ure of Autli�or
19_Pay19_
Lesser o( 1/2 Homestead
Valuation or 52.000
Sgnature of Auditor
I�)
(8)
Signamre ot Assessor
STANDARD
E
ASSESSED I HOMESTEAD
VALUE VALUE
Ne use and portion
NON-RESIDENTIAL
VALUE
Dare signed
Date signetl