Homestead_Smith (11)(ME ���� • . �
eE '" '4, CLAIM FOR HOMESTEAD PROPERTY TAX ,• �`
z��� CREDIT/STANDARD DEDUCTION . �
.. .�, .,�� State Form 5473 (R2 / 5-92)
ieu • • , � .
INSTRUCTIONS: See reverse side lor7iling instructions.
FORM
HC10
YEAR
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I iWe) � 1���� certify that o��e 1st �ay���rch. 7��
��)yccupied as our ,ncipal place of esidence the following des ribed real property for which a Homesiead Property Tau Credit is hereby daimed:
i (We) owned ❑ Are buying under contract . - � �.T �L, . .
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❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and ihat owns ihe property o�iisLFniy�r��d�r a contract.
� � - CONTRACT RECORDED � -
It buying on contraa, fee Simple owner's name � � � . . .
Recorder's oflite where contrad is recorded Record number Page
�� ���a ��
If any portion of the residential simcture or , e I.
of ihe property utilized [o produce income.
ai_i�_��_
� PROPERTY DESCRIPTION �
ship . . Taxing "sirict (cit own. township) , ,
I tle ' tion
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not exceeding one (7) acre that imm iately wrrounds thai structure is used to produce income, deSCriDe ihe use antl portion
_ Gcb. �a.� _
PROPERTY OWNED BY CLAIMANT IN OTHER COUNT�ES
Counry Township Counry Township
I�eby certify the above siatemems are irue, correci and wmplete. Sgna� ot Caimam
Atltlress (numberarMsbeef. city, sfate. ZlPwde)
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately
surrounding resideniial improvements. (�)
Oiherland (z)
Total land (line 1 plus line � g �
1)
Dwellin9 (4)
Residential improvements
Garage (5) � _ '
Other improvements (6)
Total impwvements Qine 4 through lina � ��7) �
Totat value (line 3 p�s line 7� (g)
I hereby certify ihe above is irUe. correci. and Signature of Assessor Da;e signetl
complete.
Vo.ityi tion - Signature of Au ' or Date signed
i
STANDARD DEDUCTION ALLOWANCE
19�'�Pay 79 �—
Lesser of V2 Homestead
Valuation or 52.000 �
SgnaN f Audiror Date sgned