Homestead_Jordant_
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' CLAIM FOR HOMESTEAD RROPERTY TAX
° CREDIT/STANDARD DEDUCTION
� State fwm 5473 (R6I4-W)
' � Prescribed by ihe Departrnent of Locel Govamment Finance �
INSTRUCTIONS: See reverse side for filing in{tn�ction��
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� FORM
� — HC10 !
YEAR
.,._ . :..,_ -. � . :._.,:-.. .,, �_.,� �..- , ., .--..... ��. � ,. - .
. . . _. ..._ ...> <. . �.•.... . ... .� ,
� �8� . . - � - � - -.. _ ..... . . certify lhat on �etst day of M�a�rch. 20
I(We) occupied as our prindpel piaca of residence the owing desuibed real property for which a Homestead Property� �Tyayc �Credit is hereby Gaimed:
�(We)owned ❑ Nabuyingundercontract !�'��'Q�
� Have a benefidal interest in Ne enGry that is IiaWe for the properry t�es on the property and Nat owns the pr��6d�s�W{i��iid�i���act. �
tl buy'u�g on contract, Fee Simple ownets nema
Recordels atfice where tantreU is recwded
Counry Twnship
Parcel number L I destrip on
u - -ao � 3 �-a-
If arty pation of the residenlial shuc[ure or Ne land not e:ceedinp ona (1) eae thet imr
of Ne O�PeM uG�ed to Woduce incane. �, ���
Counry
Tonnship
I hereby cer6fy the above stetemenLS ere We, cortect and complele.
�RSS (number and streef, city, afate, ZlPCade)
— a�
Is
Rewrd numbar
town,
Page
�e question:
Real property ❑ Moblie Home (I.C. &7.1-n
strucWra is used to produca income, desaibe Na use and poNOn
��, �_�''�`��`'-��``?'��''fr�.'�'*� � �!v TRUE�TAX'��.,5 ASSESSED�VALUE � HOMESTEAD ��'�'s� NON�RESIDENTINL� .='}`
`�` � ?.`�' `�ASSESSOR USE40NLY,}�o .;�,t� � �a�€.�VALUE �� m tYsc-v�VALUE�i �.r �s.F�. ��+'''.VALUE"!' �`' '�'�.
�i>,.. �t. _�'�cc3rs.TSr"'q+...�a-�1..°3�`^�n � . t Y � : : ATi100% OF TN �
- .1; .ia:.,.,.. , t � _�1 c`x
Land not exceeding 1(one) acre�immediatey '��� ''�^.�".-'*� t i-�a''�, ;yo`
. surrounding residential improvemants. ��� ,,,ri F�,. i:'j'�,`�. �r,. ��."Y.�;:
Other land �2� - :��F ' *{ �� �
TUaI IarM (line 1 plus line 2) (3�
�-t ,�� -�`�' �.-,.:r t��.
Residential improvements orMnuaOy �����9 (4� .,<� � �;,,�4 .. �'' �'�` *�aT�
Assessed Mobile I Manufactured Hwne ;;� � � .. -�' �,�,�„�: ��� z '
Garege �5) .. � � -�' � -, •:
�.`_= ;`L �-^;� a=yC. -�n
i•
S �x 5 . 4_
O�qeYimprovements (6) - :� `>'�_'' ���
. si�.`�in��M'ra _
T�el improvements (line 4 th�ough li�re 6) �7� ,
Tctal value (line 3 plrs line � (g�
I hereby certify Ne above is We, cortect, and � Sipnawre ofPSSessor Date sipnad
comptete. � .
Veriying action - SiBnature oflwditor Date signed
20 _ Pay 20 _
lesser of 1/2 Homestead
Valuatio� w 535,000
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