Homestead_Jenkins,_;,.
C�`'e� °\ CLAIM FOR HOMESTEAD PROPERTY TAX
ea��': CREDIT/STANDARD DEDUCTION
� S�ate Form 5473 (R2 / 5 92)
.J
INSTRUCTIONS: See �everse side /orliling inst�uctions.
FORM
HC10
YEAR
�
I (We) '��/.I.Q /�,�a I � � /j (�(_/y� /],._ I thayF on��l March. 1 �
,I '°�'!e) occupiea.es our princi place o idence Ihe lollowing described real property for which a Hom��rdperty r dit hereby claimed:
We owned �a�
( � ❑ Are buying under contract
] Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns tl��a�eny�r �g under a contract.
II Wprg on contract. Fee Simple o�
RecorOer's oifice where contraa is
Coumy
r:
name
PROPERTY
tlisiritt (city. fown. fownship)
Record number
Page
Y q nUmber Legal tlescrip�ion
-r���3s_� � � .� �1-3-�a ,aoA�
If any portion of the residenlial structure or ihe land no1 exceetling one ( 7) aue Ihat immediately surwuntls thal strucWre is used to produce income. describe lhe use and portion
oi Ihe property utiiizetl lo produce income.
Caumy
- /7-D� �z10- �/. 7..3� = Q�1
�'� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Township County
� cenity the above statements are true, correct and complele.
(number and sheef. ciry. state, zIP cnde)
ASSESSOR USE ONLY � �
Land not exceeding 1(one) acre immediately
surrounding residential improvements.
Otherland
Total land (line 1 plus line 2�
Dwellinq
Residential improvemenis
Garage
Other improvemenis
Total improvements (line 4 lhrough line �
Total value (line 3 p6s line 7)
I hereby certify the above is irue, wrrect, and
complete.
Ve�ilyirg actbn - Sgnature ol Autlitor
19_Pay19_
Lesser of 7/2 Homestead
Valuation or $2,000
TRUETAX . I ASSESSED I HOMESTEAD
VALUE VALUE VALUE
1�)
I21
(3)
(4)
(5)
(6)
1��
(8)
Signature of Assessor
5
NON-RESIDENTIAL
�(ALUE
Da�e signed
Date signed
Dale signl i 4 ,