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CLAIM FOR HOMESTEAD PROPERTY TAX' FORM
=y CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R2 / 5 -92)
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INSTRUCTIONS: See reverse side for filing instructions.
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I (We) certify that on the 1st day of March, 19
e) occu as our principal place of residence the following escribed real property for which a Homestead Pro lc edit Imed:
I (We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propenylpryF hyyipg yyj¢�y a contract.
_ - CONTRACT RECORDED -
If buying on contract, Fee Simple owner's name
Ay"UBSON OltMTY A.UWTOR
Recorder's office where contract is recorded Record number Page
-- "• PROPERTY DESCRIPTION
County
Township
Taxing district town
to" h- 1 -'
,9e,-cgj�u�be, —
Legal description
If any portion of the residential structure or the land not exceeding one (t) acre that immediatety surrounds that structure is used to roduce mcome, describe the usa`35615ortion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
rcertify the above statements are true, correct and complete.
Address (number and street, city state. ZIP code)
k?' P 2 &,q ^,,, / gL j4
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding t (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
_ r
Date signed
19 _Pay 19_
Lesser of 1/2 Homestead
Valuation or $2,000
STANDARD DEDUCTION ALLOWANCE
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Signature of Auditor I Date signed