HomeMy WebLinkAboutHomestead_Moore' � �_ _
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E��� � i CLAIM FOR HOMESTEAD PROPERTY�TAX
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CREDITISTANDARD DEDUCTION
y�y .,�I� State Porm Sa73 (R2 / 5-92) �
I w• r . .
INSTRUCTIONS: See reverse side 7or /iling inst.uctions. �
�\' � ' ' � - � CFRTIFICATI
FORM
HC10
' ���
YEAR
I(We) \sl���_, 1 1(� certify that on the isi day of March, 1�3_�
I(We) occupied as our principal place of residence the following described real property for which a Homestead Prope x Credit i er Gaimed:
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e) owned ❑ n�e buyinq unde� cont.act AU DITOR
_�lave a beneficial interest in ihe entity that isliable for the property taxes on the property and ihat owns the property or is buying under a contract.
tl buyirg on coniraq, Fee Simple owner's name
Recordef5 oftite where tontrac� i5 recorded
PROPERTY
Counry . owns � .� .. . .
_ ' ��
Parcel number Lega� ip:ion
o�q��3��� � ��l �- i�� �i a
If any portion of ihe resitlential stmcwre or the land not exceeding one (11 a e that imrt
af the pmperty utilized ro produce income.
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Rewrd number Page �
n�A� �
3 di rict (c?y, fawn, fownship) ' ,_ .
/�AI�C�.-�{`^
surmunds Ihat sirucWre is usetl m produce income, descnbe ihe use and portion
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES '
Counry TownShip - Coumy TOwnShip
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I hereby certify the above statements are tme, correcl and complete. Siqnamre of ciaimam
^55 (numbei and sfree7, city. sfate, ZIP code) �
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL •
VALUE VALUE VALUE VALUE
Land noi exceeding 1(one) acre immedialeiy
surrounding residential improvements. (�) •
Otherland (p)
Total land (line 7 plus line Z� (3) �
Dwelling (a)
Residential improvemenis
Garage �g� �
Other improvements (6) �
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line � (g�
I hereby Certify the above is Irue, correCt, and Synamre ot Assessor Dare signetl
wmplete.
Veritying action - Signature ot Auditor Date signed
19_Pay19_
Lesser of 7/2 Homestead
Valuation or 52.000
SgnaWre
S
ALLOWANCE