Homestead_Readere�-'"�°. CLAIM FOR HOMESTEAD PROPERTY TAX
i;E�': CREDIT/STANDARD DEDUCTION
., .�y ,���� State Form 5473 (R2/5-92)
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INSTRUCTIONS: See reverse side lor (iling instructions.
FORM
HC10
YEAR
�e)V� V— - ' �CLS.[-� � ,�i��K/ � l-��Gl,f � _"� "' _ �ertify thai o t y of 1
:) gLCUpied as o pr n ipa p a �� ��„ e following desaibed real property for which a Homestead Proper � ax�rs it' � la' ed:
% -
� I (We) owned Are buying under contract _. . . ;�� , ���
❑ Have a beneficial intere5t in the entiry that is liable for the pmperty taxes on the prOperty and that owns the property or g unde tract.
If buying on conuact, Fee Simple owner's name
Recortler's ottice where contract is recordetl
Counry
Townsttip
RECORDED
PROPERTY DESCR��,
Taxing
Record number � Page
� ' W � � � ��� , . . . . . ' � �
If any portion ot the residential strucmre or the land not exceeding one (1) aae ihat immediately surmunds that structure is used to protluce income, describe the use and portion
of ihe property utilized to produce income.
. i . � . _ . . - ,
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' Qo2/ ' .
PROPERTY OWNED BY CLAIMANT IN OTHER COUN'fIES
Counry Township Township
eby certify lhe above statements are lrue, correct and complete. I ignamr claiman� .
Address�n , elyasbe�at fate.ZlP I� / �/ D� �����
C / � U N
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land noi exceeding 1(one) acre immediately
surrounding residential improvementa (�) �
Other land (p)
Total land (line 1 plus line 2� (3) I
Dwellin9 (4)
Fesideniial improvements
� Garage (g) _
Oiher improvements . (6)
Total improvements (line 4 thmugh line � (7) .
Total value Qine 3 p6s line � �g)
I hereby certify the above is lrue, correct, and Signamre o� nssessor Date signed
camplete.
.�'ying aciion - Signature of Autlimr I Date signed
L
79_Pay79_
Lesser ot 1/2 Homesiead
_ Valuation or S2.000
STANDARD DEDUCTION ALLOWANCE
S
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