Homestead_Straw���'�"°- CLAIM FOR HOMESTEAD PROPERTY TAX
�° CREDIT/STANDARD DEDUCTION �
.
�� State Fortn 5473 (R2 / S92)
'��'a
INSTRUCTIONS: See reverse side lor liling inshuctions.
FORM
HC10
l�i � r ��.M''j
�� �' � ; �j.'s N jt
YEAR
xr':
�"� � � CERTIFICATION STATEMENT ' �
� v Wv
I(
place of reside ce Ihe following descnbed real propeAy for which a Hom _ ad Property%T � edit is reb laimed:
,�::�c.�.✓-�t �! �
�I (We) owned ❑ Are buying under contract � . � _ __ _ . _.� � � ,,.J: ,_„ ..: ���TQ^
❑ Have a beneficial interest in the entiry that is liable for the property taues on the property and that oivns fhe pPoperty or is buying under a contract.
CONTRACTRECORDED � ' �
If buying on contract, Fee S"unple ownels name
Recortlefs oHice where contract is recortletl Recortl number Page
PROPERTY DE$CRIPTION
Co ry, Township Tari dis[rict (ciry, rown, mwnship)
Panr e^l number L I description �/ ��
W — QQ 7 l'
It any portion oi the residential struc[ure or the not e:ceeding one (7) acre ihat immediatey sunounds that sWCture is used m protluce income, describe the use and ponion of
ihe proPerry utilized to praduce incame.
G-/�-a� �a_a�a �73-a�/
PROPERTY�OWNED BY CLAIMANT IN OTHER COUNTRIES
Caunry Township CWnly Township
Si nature of daimant
�ereby certify the above statemenis are true, correct and complete. - c
e v ra I
Address (number antl street, ciry, state. ZIP codeJ I
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VAWE - VALUE VALUE
Land not exceeding 1(one) acre immediately �� �
surrounding residentia� 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 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, Correct, and Signature of Assesar Dare signed
complete.
Verifying acuon - Signature of Audiror Date signed
� � STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
Valuation or 52,000
igna re ot AuOitor Dare signed
�5- 9- �