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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / 5-92)
INSTRUCTIONS: See reverse side 7orTling instructions.
FORM
HC10
YEAR
- -.-r � .Y"�':X�
CERTIFICATION STATEMENT � ` tl �� �
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I(We) certify that on the 7st day of March, 19_
I(We) occupied our princi al lace of residence the follovnng described real property tor which a Homestead Property 7e�( Cr�ir� is ie�uepy claimed:
❑ I(We) owned ❑ e buying under contmct . � U L 1 I�y7
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❑ Have a beneficial interest in the entity that is liable tor the property taues on the property and that owns the pro �erty or is buying u�dCr a co tiact
cti.r..': �!iY��� o
CONTRACT RECORDEO � "'' " ' `""' � '
If buyirg on conuact. Fee Simple ownefs name
Recorders oKce where wnuact is recorded Record number Page
PROPERTY DESCRIPTI
n Township Tacing dis �(ci wn, f wnship)
Parcel mber LegalOescription
�OS-O 0- 3�-3 - . �
If any portion of ihe resitlenGal sWtlure or ihe lantl not exceeding one (1) acre t at immediatey rrounds Nat siructure is usetl to protluce income, descnbe Ihe use and ponion of
Ne praperty uWized to proGuce ir�come.
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� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry - Township
ure of Uaimant
�reby certify the above statements are true, wrrect and complete.
Adtlress (num6er and st2e1, ciry, state, ZIP code) �
/ � YJ //� ,�-Z��z- 5� � � 3
ASSESSOR USE ONLY T E TAX ASSESSE HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
l.and not exceeding 1(one) acre immediately (»
surrounding residential improvements.
Otherland (2)
Tota� land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements .
Garage (5) �
Other improvemenis (6)
Total improvemenis (line 4 thiough line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, correct, and Signature of Assemr oate signed -
complete.
Venfying ac6on - Sig�ture of Audiror Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 79 _
� Lesser of 1/2 Homestead S
valuation or $2,000 �
Sgnatur oi tlitw Da[e signetl
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