HomeMy WebLinkAboutHomestead_Dyehouse (3)'' CLAIM-FOR HOMESTEAD P.ROPERTY TAX
CREDIT/STANDARD DEDUCTION
t Siata Fwm Sa73 (R6l d-03)
' Pmscribad by tha DepartmeM of Local Gwamment Flnance
� INSTRUCTIONSr See reverse side for �ling insfi�ctions.
- i, -�
FORM YEAR
HC10
��B) � certify thet�KQ�e 75t 8e�ofUlarch, 20_
I(VJe) occupied es our prindpal place of residence fdlowing described reat property tor which a Homestead Property Tmc Credit `(s h-e�reby Gaimed:
,� 1(VJe) owned ❑ Ne buying under contract �%(p� ��+�.
Have e benefidal interest in the entity Nat is liable for Ne property teues on the property and ihat owns the��g��r��py�Flp &U12{�nVacl.
II buying on conVeq, Fee Simple mmefs name
Recordafe office where conVact is recarded
County
County
Tnmship
r.�ar��na�c,c> ie�uuux_ uara�
in of the residential strucWre w the land not axceeding ona (1) eae that
irry utllized ta ptoduca income.
I hereby cer6ty the above sletemenLS are We, correct end complete.
�2ss(�upibelanQsvaet ,state IPoode) /�1
Land not exceeding 1(one) acre immediatey
surtounding residential improveme�ts.
Other land
Tatal land (Ilne 1 plus line 2)
Residenlial improvemenLS or Mnuaily �Iling
Assessed Mobile / ManufaGUred Home
Garege
improvements
7ctal improvements (line 4 through lirre 6)
Tdal value (line 3 phs line �
I hereby certi(y Ne above is We, correG, and
complete.�
Verifying aWon - Signawre of Niditor
20 _ Pay 20 _
Lesser of 12 Hwnestead
Valuation or 535,000
i�)
(2)
(3)
(4)
(5)
(6)
m
(8)
SignaNra otASSessor
Record number PaBe
21PTION�,`�=. .� ='.' ` .- .� ..
. S �r � L T�: t . fi+: � -:=:^• • .
> . � . . � ...:..
7 distrid (ciry, tawn, township)
I5 tAe properry in Question:
❑ Real property ❑ MobOe Hane (LC. 67.7-n
surtounds Ihat sWCNre is used to Droduce Inwme, describe Na use and portion
Counry
S
of Ga'unant
Twvnship
DaU signed
Date signed
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