HomeMy WebLinkAboutHomestead_WinkelCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R215 -92)
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INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT. AM1A� 1U7 - d
I (We) certify that bffthe &&4, ,QgQarch, 19_
0 occupied as our principal place of residence the following described real property for which a Homestead Property Tax Cred /it is hereby claimed:
*(We) owned El Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that own eroperty or�s'huy 4ef R tract.
CONTRACT RECORDED
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
ry
I PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES I
Township
certify the above statements are true, correct and complete.
Address (number andstreet. dry, state, ZIPcode)
ASSESSOR USE ONLY -
PROPERTY DESCRIPTION
ASSESSED
VALUE.
Coun
Township
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Taxing district town, tow ship)
Otherland
(2)
J
Total land (line t plus line 2)
(3)
P�rOnumber ���� -00
IYJI I/
Le a on
4�- 3 -5
Dwelling
It any portion of the residential structure or the lard not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
I PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES I
Township
certify the above statements are true, correct and complete.
Address (number andstreet. dry, state, ZIPcode)
ASSESSOR USE ONLY -
TRUE TAX
.VALUE
ASSESSED
VALUE.
HOMESTEAD
VALUE
- NON
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(2)
Total land (line t 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 pills line 7)
(S)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
19 _Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
Date