Homestead_Kerneyd % ^,a
CLAIM FOR HOMESTEAD PROPERTY TAX
a
i;
CREDIT /STANDARD DEDUCTION
Township
State Form 5473 (R215 -92)
I (We)
INSTRUCTIONS: See reverse side for filing instructions.
occupied as our principal place of residence the
property for which a
A (We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property
N
FORM YEAR
HC10
the 1 st day of March, 19
Tax Credit is hereby claimed:
under a contract.
CONTRACT RECORDED -
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
--
PROPERTY DESCRIPTION -
County
Township
Township
Taxing district (city, town, township) '
ParOnumber
Legal description
I 3
_
Oi
Otherland
W 3_ t
If any portion of the residential structure or the land not exceeding one (1)
acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
Total land (line I plus line 2)
�Zo o?� �� 0?40 - '9,00.
6c'?O -a0/
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
-1
certify the above statements are true, correct and complete.
Sig
Sig azure of claimant
Address (number and street, city, state, ZIP code)
ASSESSOR USE ONLY
TRUE TAX
,VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Signature of Auditor `
Date signed a
Otherland
(2)
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
-
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
L A
V STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
5
Signature of Auditor `
Date signed a