Homestead_WalburnCLAIM FOR HOMESTEAD PROPERTY TAX
'" _ CREDIT/STANDARD DEDUCTION
� � Shata Form 5673 (RS / 10-01)
� Presaibed by ihe Deparhnent of Local Govamment Finance
INSTRUCTIONS: See reverse side for (ling inshuctions.
FORM
HC10
YEAR
� M'e) V�/ certify ihat on the 1st day oi March, 20_
I(We) pi as our p d I place ot residence the following descnbed real property for which a Homestead Property T�c Credit is hereby daimed:
�� �� � � �
Ll I(We) owned !ve buying under contracl
■Have a benefidal interest in the entity ihat is liable (or ihe properry taxes on the properry and that owns the rope or buyin�urJQe ad.
I( buy4g on contract. Fee Simple owners name
County
ofice where mntraG is remrded
Tamship
Taing
\
� Cescnptlon / Is Ne property in question:
�� O ,�,� � S�/�b(j�'{� ❑ Real WuPertY ❑ MoDOe Moma (I.C. bt.1-n .
uEential atruchire w Me land not axceeE4ip ona (1 � arre thet immed'��ds Nat swcWre is used b poduta incrnne. Cescriba Ma use ariC portbn
tu produce irKOma.
I hereby certify the above statemenLs are We, wrted and oomplete.
(num6e` arM sheet, dy, atafe, ZIP code)
not exceeding t(one) acre immediatety
inding residential ImprovemenLs.
Other land
Tdal land (line 1 plus line 2)
Dwelling
Residendal improvemenb
Garage
Other improvements
Total improvemenls (line 4 fhrough Itiie 6)
Tdal value (line 3 phs line n
I hereby certify the above is We, corred, and
complele.
Verityirn� action - SignaNre of Auditor
(�1
(Z)
(3)
(4)
(5)
(6)
1�)
Ie1
SignaNre of Assessor
�
signed
Date signed
s°�,,�� j�'..,,�'-���'�-,;�r�'����fi4�STANDARU:OE�UG710N'ALIOMIAIiCE;x���.�'���syq �'�'b'FS:,'�s".����':���,�+.3 � '
20_Pay20_
Lesser of 1/2 Homestead $
Valuation or $6,000
Sigrehue oflwditw ' Date signed