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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION _'
State Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side forliling instruaions.
FORM � YE
HC10
� CERTIFICATION STATEMENT �
I(We) certity that on the 1st day of March, 19_
I(We) occupied as our principal place of residence the following describ real property for which a Homesi ro e ax C sqq�whqv claimed:
❑ I(We) owned ❑ Are buying under coniract p�9 9�
rJ Have a beneficial inierest in the entiry that is Iiabie for the properry taxes on the property and that owns the property o b ��ccontract.
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' CONTRACTRECORDED „ "
It buying on contract, Fee Simple owners name � -
Recordefs off�ce where convact is recorGeO - � n rLbErUDITOR Page
PROPERTV DESCRIPTION
Counry Township Ta�cing district (ciry, mwn, township)
P rcel num6er Legal descnp6o
-D I �fs3 -OD -�.5�- � 1
If arry portion of ihe residential siruaure or ihe land noi exceeding one (1) acre Ihat immediatey surtounds ihat swcture is used to produce incwne, describe ihe use and ponion of
the properry utii¢ed ro produce income. �
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PROPERTY OWNED BY CLAIMANT IN OTHEfl COUNTRIES �
Counry Township County Township -
Si na re of claimaN
I hereby certify the above statemen[s are true, correct and complete. /�� ._�„ �� -
lMW r.v-a�
dr ss (number antl sveeL ciry, state, ZIP oode� �
R23 Bo,C �iBA Ou�er�rr.11� l N y�6 6S "
I ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
nd not ezceeding t(one) acre immediatety (� �
�rrounding resideniial improvements.
Other land (2)
Total land (line 1 plus line 2) (3)
Dwellin9 (4)
Residential improvemenis -
Garage (5)
Other improvemenis . (6)
Total improvements (line 4 through line 6) (7)
Totai value (line 3 plus line 7) (8)
I hereby certify Ihe above is Irue, cortect, and Signamre of Assesor Daie signee
complete.
Verifyi� az6on - Signamre of Auditor Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
Valuation or S2.000 �
GanaWre of Autlitor Date signed
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