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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R2 / S92)
FORM
HC10
YEAR
�� INSTRUCTIONS: See reverse side lor filing instrvctions.
�� CER FI ON ST ENT _
I(We) • certify that Uc�QFp 7�t q�ypoN6rch, 19_
h 1 �`
I(We) occupied as our pr n' at plac e e following described real property F which a Homestead Property ax Credit i ereby cl ime
❑ I(We) owned ❑ Are buying under contract .
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and ihat owns the pr ' ��qQ1F3ci
GIgSON C
CONTRACT RECORDED
If buying on conVact, Fee Simple owners name �
Recorders office where contract is recorded Recortl number Page
PROPERTY DESCRIPTION
Caunry Township Taring district (city, town, lownship)
Parcel num = � Legal tlescription q� �—' ��
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I any ponion of Ue resitlenUal struMUre w ihe land not ezceeding one (1) acre that immedarety surtounds that swcture is used ro produce income, describe ihe use and portion of
Ne propefty utilize0 ro protluce inwme.
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry TownShip Counry Township
Signature of i ant /h
_reby certify the above statements are true, correct and complete.
A dre ber treet, ciry, sta , code \ • �/� �
/lI lX x�- CJ
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VA�UE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (� �
surrounding resideniial improvements.
Otherland (2)
Total land (line 1 plus line 2) . (3)
Dwelling (4)
Resideniial improvements
Garage (5)
Oiher improvements (6) �
Total improvements (line 4 througA line 6) (7) I
Total value (line 3 plus line 7) (8)
I hereby certify Ihe above is true, CArreCt, and Signawre oi Pssesor ' Date signed
wmplete.
Verilying actim - SignaWre of Audimr Da[e signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
Vatuation or 52.000
Signature of Auditor Date signed