HomeMy WebLinkAboutHomestead_Ross (5)i�'E �(Q
; �� CLAIM FOR HOMESTEAD PROPERTY TAX
'� CREDIT/STANDARD DEDUCTION
:..�;;�� State Form 5a73 (R2 / 5-92)
,m
INSTRUCTIONS: See reverse side /orliling instructions.
FORM
HC10
�
I�We��_y [Jf f(�,_,_AJ •�,J ��j{1�F� cenify that on the 7st day of March, 79 I�
���) occupi as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
',_�"i I(We) owned ❑ Arebuying under contract ��T�. g'�
❑ Have a beneticial interest in the entiry that is liable for the property taxes on the property and ihat owns ih��ty�� is q�ng QjidQd a contraci.
� . CONTRACT RECORDED � tiC. K� �
Ili buying on coniract. Pee Simple owner's name ' r'""
I Recorders oflice where contraci is recorded � ,eco, ldaum�Ger ° Page
AUD�TOR
County
1: any
ot the
� PROPERTY DESCRIPTION
Township Taxirg district (ciry, town, s ip) �,
Legal tlescription
� � _oo
:itlential strucwre or the land not exceeding one (71 aae ihat immediatety surrounds iha[ sirucNre is usetl to
ro protluce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
p County
�by certify ihe above statements are true, correct and complete.
Address (numbe� and streeL ciry. state. ZIP cotle)
ASSESSOR USE ONLY
Land not exceeding 7(one) acre immediately
surrounding resideniial improvements.
Otherland
Total land (line 7 plus line 2�
Dweiling
Residential improvements
Garage
Oiher improvements
To�al improvements (line 4 through line �
Total value (line 3 p�s line 7�
I hereby cenify the above is true. correct, and
camplete.
��fvina action - Sia ur o� Auditor •
,
79_ Pay 79_
Lesser of 7/2 Homesiead
Valuation or 52.000
Sgnawre of
TRUE TAX
VALUE
(�)
(2)
(3)
(4)
(5)
(6)
l�)
(8)
Signature ot Assessor
S
claimant
ASSESSED HOMESTEAD
VALUE VALUE.
i�ome, tlescribe the use and portion
Township
NON-RESIDENTIAL
VALUE
Date signed
Date ned �
�-s-9
Date si p� S� n�
J 7