Homestead_Holzmeyerrt�� �, CLAIM FOR HOMESTEAD PROPERTY TAX
' = CREDIT/STANDARD DEDUCTION
; � Sfate Fwm 5473 (R4 / &00)
INSTRUCTIONS: See 2verse side for filing ins6uctions.
FORM (n. Y R �
HC10 f ` � b�. .
I ��'V' `� ��+�/�,�U "")��/� Ir"�' W Vcertify that �ryhe�st day of Mar�, 20�
I e) occupied our principal place of residence the following desuibed real p erty for whi a Homestead PropeAy TaSCredit is hereby daimed�
,. �L+
I(VJe) owned ❑ Are buying under contract
�ave a beneficial interest in the entity that is liable for the propeAy taxes on the property and that owns the
It buyinq on conVacl, Fee Sunple ownefs name
Recorders offxe where contract is recorded
Counry
It any portion of
W the property i
o(�'biiying undeQ��ntreG.
Record number � Page
Tavnship I Tain� tl�Ui�, (uryTown, townshrP)
\I1 � �M
SV\t./J � —
Legal descripiion
! Wntl frot exceeCing one (1) aue Nat immetliatey surtounds Nat struUUre is useE to protluce Ncome, describe the use anE
I hereby certity�lhe above statements are true, corred and wmplete.
P�dreu (num6er and street cd}; state, ZlPcode) �
Land not exceeding 1(one) acre immediatety
surtounding residential improvements.
Other land
Tdal land (line 1 plus line 2)
Dwelling
Residential improvements
Garage
Oiher improvements
Tdal improvemenis (line 4 through line �
Total value (line 3 pl�s line �
I hereby certify the above is We, corteG, and
complete.
Veirying aUbn - Si9nature oflwditor
(�)
(2)
(3)
(4)
(5)
(6)
(�)
(8)
SignaNre of Nssessor
01
6
Date signed
Date signed
'" �'�,�.c��s,-��T�'°<�-'���°'� - � �,-�..•5T/WDARD:DEDUCTIONALL`OVVANCEjp�".€„�-'-."'�'�t'�� „�ja,�J: �z:y=���;j'3�.°fc',y`•�";,L�
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20 _ Pay 20 _
Lesser o( 12 Homestead
Valuation or $6,000 $
Sgnature otFwditor Date signeA