HomeMy WebLinkAboutHomestead_LashbrookST�„ CLAIM FOR HOMESTEAD PROPERTY TAX
i 4� CREDIT/STANDARD DEDUCTION
.
��� i' State Fartn 5473 (� / 5-92) . .
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16
INSTRUCTIONS: See reverse side (or (ling inshuctions.
FORM
HC10
YEAR
CERTIFICATION STATEMENT
I(We) �S .i certify thai on the 7st day of March, 19_
I(VJe) occupied as our principal place of residence the following described real pmperty for which a Homestead Property Tax Credit is hereby claimed:
❑ I(We) owned ❑ Are buying under coniract
❑ Have a beneficiai interest in the entity Ihat is liable for the property taxes on Ihe property and that owns the pwpe or is b��u er coniract.
CONTRACTRECORDED � �• �
Ii buying on contract, Fee Simple ownefs name _ ��v O�'
1
Recorders office where contract is recortled . Record num age
1
PROPERTY DESCRIPTION � "�.�i� Y A
Counry \ Township// Ta�dng tlistrict ry, fown, rown �p)t.t �
.� Gf n/� o:✓ G�n/, o,�
Parcel number Legal descrip6on
007- oos�9-o a ..
It any portion of Ne residentlal swc[ure or Ne land not exceeAing one (7) acre Nat immetliately surtounds that simcture is used to produce income, descdbe ihe use and ponion of
the properry utilized ro produce income.
aC-�9-o�-/�a-G�• � 99-���
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
Si na f aimant
ereby certify the above statements are true, cortect and comptete.
Atltlress (number and stree(, city, stafe, ZIP cotleJ
S ,i �-
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
. VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (��
surrounding residential improvements.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvemenis
Garage (5)
Other improvemenis (6)
Total improvements (line 4 th�ough line 6J � (7)
Total value (line 3 plus line 7) (8)
I hereby Certify lhe above is true, CorreC�, and SignaWre of Assesor , Date signed
complete.
Verifying action - Sgnature of Autlitor � . Date signed
STANDARD DEDUCTION ALLOWANCE �
19 Pay 19 _
L er of 1/2 Homestead S
V lu � S2,000
Signature of Audiror Da[e signed
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