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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sta[e Fofm Sa73 (R2 / S92)
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FORM VEAR
HC10
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CERTIF7CATION STATEMENT � �
I(We) �" ify that on the lsi day of March, 79_
I,�(4,V�e) occupied as our principal place f esidence following described real property fo erty Tax Credit is hereby claimed:
(�"I (We) owned ❑ Are buying under contract .
❑ Have a beneficial interest in the entiry that is liable for the property taues on the property and that owns the property or is buying under a coniract.
- CONTRACT RECORDED -
If buying on contracl, Fee Simple ownefs name
Fecordefs office where con[2ct is recorded - Record number Page
� PROPERTY DESCRIPTION -
Counry Tovmship T" g tlistrict (ciry, town. fownship)
Parcel number Legal scription
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If any portion oi Ne residen6al sWCture or the IaM not ex mg one (i) acre that immediatey surtounds Ihai sVUCture is used to protluce income, tlescribe Ne use antl portion of
Ne pro0erry utilized m protluce incame.
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Tovmship
Signature olClaimant
„reby certify the above statements are We, correct and complete. -
Address (number and slreel, ciry, sfafe, ZIP codeJ '
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding t(one)acre immediately (�)
surtounding 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)
I hereby cedify the above is true, correct, and Signawre of nssesor Date signed
complete.
Verifying action - SignaWre of Auditor Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead ry
Valuation or S2.000
S�t e of Audit r ate signed
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