Homestead_Wagner�. R.,,
e�/^ °, CLAIM FOR HOMESTEAD PROPERTY TAX
;��: CREDIT/STANDARD DEDUCTION
.�.,;� State Porm Se73 (R2 / 5-92)
�.� :
�m
INSTRUCTIONS: See reve�se side !orliling instructions.
. " � � . .. . ' - CERTIFICATIi
FORM YEAR �
HC70
1 I(We) _� d� � o e.���'���_� ��� certify that on the 7gf a��t�rcbn
I(We) occupied as o� principal ace of residence the tollowing described real property for which a Homestead Property� T,/ax Credit is hereby`ryc Imed:
� (We) owned ❑ Are buying under contract.. . . 'tiY�h/q�J!',� �'`,
(,—r Have a beneficial interesi in the entity that is liable for the property taxes on the propeny and ihat owns the property or is bv9iag t2ci
- CONTRACT RECORDED - � � � �
If buying on contrau, fee Simple owner's name � . �
Recorder'S Office where contraa i5 recorded Record number Page
PROPERTY DESCflIPT10N
Counry Township . . ' T� g district (ci fowq township)
Parcel number legal description
^Q�
If any portion of the resbential SlrucNre or Ihe IarW not exceetling one (7) acre ihat immediately surmunds ihat siructure is used to produce income. describe the use antl portion
of the property utilized m protluce income.
Coumy
PROPERTY OWNED BY CLAIMANT IN OTHER COUMIES
Township Counry
certify the above siatements are true, correct and complete.
'numberandstreeCdry.stata-� code)
��Z I�nX I�S t�r�nn_a��.�. TN
. ASSESSOR USE ONLY
Land not exceeding 7(one) acre immediately
surrounding residential improvements.
Otherland
Total land (line 1 plus line Z�
Dwelling
Resideniial improvemenis
Gara9e
Other improvemenis
Total improvements (line 4 through line �
Total value (line 3 p�s line 7�
1 hereby certify the above is true, correci, and
complete.
Verityirg adion - Signature of Auditor
19_Pay19_
Lesser ot 1/2 Homestead
Valuation or 52.000
TRUE TAX
VALUE
(�)
(Z)
(3)
(4)
(5)
(6)
l�)
(8)
Signature of Assessor
claimant
ASSESSED I HOMESTEAD
VALUE VALUE
STANDARD DEDUCTION ALLOWANCE
S
Township
NON-RESIDENTtAL
VALUE
Date sgned
Date signed
Date signed