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E^� GLAIM FOR HOMESFEAD PROPERTY TAX
s���!= CREDIT/STANDARD DEDUCTION
State Form 5473 (R2 / 5-92)
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INSTAUCTIONS: See reverse side lor (ilrng instructions.
FORM
HC10
YEAR
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I �/�,G�����%<�__�y1�.�iy-�G� ce dy at t QAarch, t9�
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1(we7 oc�cupied as our principal place f residence ihe following described real property for which a Homestead Prop Credit is hereby claimed:
I (We) owned ❑ Are buying under coniract � . � �. �y, , „�s
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❑ Have a beneticial interest in the entiry ihat is liable for ihe property taxes on ihe pmperty and thai owns the pmperty �����d2r a contract.
.CONTRACTRECORDED � " -
If buying on contracC Fee Simple owner's name � . ,
Recorder's oHice where contract is recorded Record number Page
' - PROPERTY DESCRIPTION
County � Township Taxirg distr t! y, t
Parcel mb r Legal de i on
�/ � �d �
If any ponion of fhe residential strucmre or ihe la d noi exceedirg one (7) aue that immediatety surrounds Nat
ot ihe pwperty uGlized m produce income.
0
is used to protluce income, descnbe ihe use and portian
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
p County_ �_
I hE =.oy certiry the above statements are irue, correct and complete.
Address(numberandstreet,city,state,ZlPcode). � „ � _
'7G � $' - / 13 �
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL:
VALUE VAIUE VALUE VALUE �
Land nol exceeding 1(one) acre immediately
surrounding residential improvements (�) ��
Otherland (2)
Total land Qine 1 plus line 2� (3)
Dwelling (4) - � �
Residential improvements .
Garage (5) •
Other improvements (6)
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line 7� �g)
I hereby certify the above is true, correct, and Signamre o� nssesmr oare signea
cor�!ete.
� action - Sgnature of Autlitor Date sgned
Autlitor
7� Pay 79�
Lesser of t/2 Homeste
Valuation or 52,000
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STANDARD DEDUCTION
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Dare sign