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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� sm�e F«m s�r.i (RS / amI
� Presaibed by tM Depertment oi locel Govemrtant Finar�ce
INSTRUCTIONS: See re�arsa rldi kr fStp inebuctipn.
FORM �1 � YEAR
HC70 �
I(4Ve) L L'// ' certiy Ihat on the tst day of March, 20
I(We) oaupied as our principa ce of residence the following described real property for which a Homestead Propert�Cr�dies�(�y daimed:
❑ I(We) owned ❑ e buying under contrect �—y„
, Have a benefidal in[erest in the entity that is liable for the property taxes on Ihe property and ihat owns the property�o("�uyi{g?u(l�er a wntract.
If buying on conirad, Fee Simple ownefs name
Reoorders olfice whera conVaa is recorded
?=i'�ti'�./���S:k':�'�'��s��'��''$�3�=�.��'Stn.,
_ t.�:, �F,��C .�l.;;EL_ _ v r
Counry Tamship
Record number � Page
rar i n mcer —7 �7 s is the Oroperty in question:
O ^ �. � / / � � �l � fe/� ❑ Real G�WartY ❑ Mobile Homo UC &/.7-71
H any poRion a( Ne resitlential sW cWre w the land na exceeding one (1) ace Nat immeCiatety wnounds Ihat swaure is used b protluce incame. deuribe Ihe use and portbn
of Ne property uhLzcd b produce income.
Tavnship
I hereby certify the above statements are We, coved and complete.
Address (num6er aM sheet, ciry, stafe, ZIP code)
Uaimant
,. .'. �-!xwb€a� a.'�ti?i�.X 's . Sz ..5s �� _ I � � �ti ��fi.�...�! �i���S-"€. 5��±3���5��'.L
-'�4r:' �cr�ir.�,"�, � � �>STANUARD:DEDUCTION�ALCOWANCE, .
20 _ Pay 20 _
Lesser of 1/2 Homestead
vauauon a 535.000 g
Signatureoilwddw " Datasigned