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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side lor filing instructions.
FORM
HC10
YEAR
v
CERTIFICATION STATEMENT �� � �
I(We) cenify that on the 1st day of March, 19_
I(We) occu ed as our principal place of residence the fo lowing d cribed real property for which a Homestead Property Tay�Ciedit� j�erqp�l�imed:
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❑ I(We) owned ❑ Are buying under contract �'
❑ Have a beneficial interest in the eniity that is liable for the property taues on the property and that owns the prope r�is buying unde contra
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CONTRACT RECORDED ' v � "� ' •
If buying on conVatl. Fee Sunple ownefs name
RecordePs oflice where contract is recorded . . Recortl number Page .
PROPERTY DESCRIPTION
Counry Township � Taxing district (ciry, mwn, township)
P rce�um r ` Le9al tlescription
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If any portion of the residenGai siructure or the land not exceedirg ne 7� acre that imm a y sunou s Ihat sWCNre is usetl to protluce i come, descnbe ihe use and portion ot
Ne property utilized to D��uce income.
- 03 - 0� LYD. �.S�Q�,S -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
nry Township Counry Township
Signamre of Uaimant . �
I hereby ceAify the above statements are true, correct and complete. � �
AddreSS (numbel dnd s12et, ciry. sfafe, ZIP Code)
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ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding t(one) acre immediately (�)
surtounding residenfial improvements.
Otherland (2)
Total land (line 7 plus line 2) (3) �
Dwelling (4)
Residential improvements
Garage (5)
Oiher improvements (6)
Total improvements (line 4 throvgh line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certity the above is true, covect, and Signature of Assesor Dare signed
�mplete.
;�iM1/inq action - Sgnature of Autlitor Date signe0
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead $ • � �
- Valuation or $2,000
Signature oF Autlilor Da��=ed —
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