Homestead_Mounts (3)1�E�F O
a �a
� ,,
�' ���
�'s't..c�.='
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Form 5473 (R2 / 5-92)
FORM
HC10
YEAR
the following described real roperty for which a Homestea Properry Tax Cre � is hereby claimed:
❑ I(We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity tha[ is liable for the property taxes on ihe property and that owns. gAy� �o iract.
CONTRACTRECORDED
It buying on contract, Fee Simple owners name
Recordefs office where conVad is recortled Record number Page
PROPERTY DESCRIPTION �
Coun Tmmship Tazing tlisin d to t ship)
Parcel number Legal descnption �
-O 7 S Df
If any portion of Ne residentlal structure or the land not excee0i� one (1) cre Nat immediatey surtounds ihat svucture is used m produce income, deuribe the use aM poNOn of
the pmperty udlized to praduce income.
-/�� - 00-�3. d� � =D�/ -
� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Tovmship Counry Tawnship
Si of imant �
tareby certify the above statements are We, correct and complete.
Adtlress (number and street, ciry, sfate, ZIP cotle) �
R 1 y S W�. N s v � L L ,.�-Yv .-� �-I �l � �05
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (� � -
surrounding residential improvements.
Other land (2)
Total land (line 7 plus line 2) (3)
. Dwelling (4)
Residential improvemenis
Garage (5)
Oiher improvements (6)
Total improvements (line 4 fhrough line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby tertify ihe above is Irue, torreCt, and Signature of 0.ssesor Date signetl
complete.
Verilying action - Signature of Auditor Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
Va tion or 52,000
Signat r ditor Date s
=a5 ��