Homestead_Knowels (2),�'�Eo
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fonn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side lor liling instructions.
FORM
HC10
YEAR
CERTIFICATION STATEMENT
I(We) �" � ity that on the.7 st day of March, 19_
I(We) occupied as our principal place of residence the following descnbed real prop for which a Ho stead Properry Taz�Credit is hereby claimed:
❑ I(We) owned ❑ Are buying under contract . . ��
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❑ Have a beneficial interest in the entiry that is liable for the property taxes on the property and thai owns the property or is buying under a contract.
CONTRACTRECORDED � �
If buying on contracL Fee Sim01e ownefs name , . �
_" ` .
Recorders office where contract is recorded Record number Page
� PROPERTY DESCRIPTION
County TownsNp Taxin istrict �aty, fo Shr )
Parcel number Lega escription
a�5-c� 4 a � �
If any portion of tlie residential stru ure or che iand not exc�ng one (1) acre that immediatey sunounds ihat sWCture is used to protluce income, describe Ne use and portion ol
ihe property utilizetl to produce incrome.
� - �- oa- oo - ���a�9_o�-i
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES �
Counry Township Counry Tawnship
Signature of daimant _�
sreby certify the above statements are true, covect and complete. �
AAtlress (nomber and s(reet, city, sfare, ZIP oode) �
ASSESSOR USE ONLY TRUE TAX ASSESSED FIOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediatety (�� .
sunounding residential improvements.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4) �
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 through line 6J (7) -
Total value (line 3 plus line 7J (8)
1 hereby certity the above is Irue, correct, and Signamre o( Assesor Date signed
complete.
Verilying action - Syna[ure of Auditor Dare signed
STANDARD DEDUCTION ALLOWANCE �
19_ Pay 19 _
Lesser of 1/2 Homestead 5
Valuati or 52,000
Signature Auditor Date signed
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