Homestead_Delong (3)� s..rF
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fwm 5473 (R2 / S92)
FORM
HC10
YEAR
��� INSTRUCTIONS: See reverse side !or (iling instructions. �
CERTIFICATION ST T ME
�I (We) � thar t �Ne�sCd��arch, 19_
I(VJe) occupied as our principal I e of residence the following described real property for which a Hom t roperty Tax � re '(' hereby claimed:
❑ I(We) owned ❑ Ar uying under contract Ip��N
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pG6pertyo�Ij�in�J utlJ���}qn act.
CONTRACTRECORDED �
If buying on conVact, Fee Simple ownefs name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
Counry Township Taring distriq (Ci , wn to r J
Parcel umb r Legal descrip � n
/ %-0 //OS-cb
If any ponion of the residentlal structure or Ne land not ezceeding one (1) acre thai immediatey surtounds that sWCture is used to produce income, describe the use antl poNon ot
Ne property utilized [o produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Tovmship - . Counry Township
Signature aimani I
nereby certify the above statements are true, correct and complete. � -
Addreu (number and street, city. state, ZIP aode)
`P e .S'� � �17�y
ASSESSOR USE ONLY TRUE TAX . ASSESSED HOMESTEA NON•RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediatety �� �
surtounding residentiat improvemenis.
1
Otherland (2)
Total land (Irne 7 plus line 2J (3)
Dwelling (4)
Residential improvements
Garage (5) .
Other improvemenis (6)
Total improvemenis (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certity [he above is true, correct, and Sgnamre of nssesor oace signed
comptete.
Verifying action - Signature of Auditw Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead � �
Valuatio or 52,000
Signature of 'tor - � Da[e si ned
� �a-a�-o �