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, � CLAIM FOR HOMESTEAD PROPERTY TAX
ir '� CREDIT/STANDARD DEDUCTION
+ State Form Sa73 (R2 / 5-92)
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INSTRUCTIONS: See reve�se side !or filing inshuctions.
FORM YEAR
HC10
, A�
. - . � _.. . . .�, . , • ^CEfii��. VI'ISIAItIMtI'IK . °^' ..S'�. '. .."L.[' .�v.... ...
I(We) _� � '-' � certify that ihe tsi day f�Mdreh. 79
L
I(We pi as ur principal ace of residence the fo owing described real property for which a Homestead Pro y Taz a's�if8
�I ) owned ❑ Are buying under contract C1a�CN CpLt�TY %'�i10� �
Have a beneficial interest in the entiry that is Iiabie for the property taues on the property and that owns the properry or is buying under a contraa.
. , - . -0ONTRACT'RECORDED�..- . .ot�. . � ow'.-. � � _� �arv: � -
If buyirg on contrad. Fee Simple owner's name
ftecortler's office where contract is recorded Reoord number Page
. . . . . . . � PROPERTYDESCR�PTION� ' � ��''-h ;�'$`"-. .. -
Counry Township Taxirg district (cily, town, lownship)
P�rcel nu r `` I�^ � Legal description
��I << y
If any pohion of the residential stmcture or the lantl not exceeding one (7 � aae ihat immetliately surrounds that ruc ure is us tl to produce income. descn6e Ne use and portion
oi the pmpeM u6lized ro produce income.
� - PROPERTY OWNED BY CLAIMANT IN OTNER COUNTiES: .� -
Counry Township Counry Township
1 hereby certify ihe above slatements are true, correct and complete. Sgnanre of ciaimam
�
�ress (numberaMs(raet ciry, stare, ZlPcode) r'
l
� .� ASSESSOR USE ONLY �� TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL:. �,
���- � VALUE VALUE VALUE � . VAWE � �
Land not exceeding 7(one) acre immediatety . ' " -`- ���
surrounding residential improvements. (�) � . - - � �
Otherland (p)
,�.�+
Total land Qine 1 plus line 2� (3)
Dwelling (4) � � , .
Residential improvemenis .
Gara9e (5) , � ,
Other improvements � (6) �
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line � (g)
I hereby certify the above is true, correct, and Sgnamre of Assessor Date signetl
complete.
Verifying adion - SignaWre of Autlibr Date signetl
�. STANDARD DEDUCTION ALLOWANCE"- . � E; . �"
- 19_Pay79_
Lesser of tl2 Homestead
Valuation or $2.000 �
Synature ot AW imr Date siqned