Homestead_Wallace (17)' : ` CLAIM FOR,HOMESTEAD RROPERTY TAX
° CREDIT/STANDARD DEDUCTION
\ State Form Sd73 (R6l a-03)
� Prcsaibed by Ne DepaNneni of Local Govemment Finance
� INSTRUCTIONS: See reverse side (or filing instructions.
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FORM
HC10
YEAR
��yye) , � ��-, -- v-- • v w v c,cX • i��,�ciW(!'l(� �ertify that on the 1 st day of March, 20_
I(We) ocwpied as our prindpal placa of residence tha foilowing described real property for which a Homestead Property Tac Credit is hereby daimed:
❑ I(We) owned ❑ Me buying under contrea g �'�
iHava e beneficial interest in the enliry that is liable for the property taxes on the property end that� tf{� p�erty�uy�g u�er a contrect.
I1 buylnp on conVaq, Fee Simple ownafs name
RBCONeYS Ofice where contraq is reCaded
Twnship
Ta�ing
Pepe
Pa(cg{,nym��� �a3/-�lepal deuriplion I I5 Ne propprty in question: U
UU V Reai proDarty ❑ Mobile Home (I.Q &7.1-�
I( any portion ol Ne residential sWCture a the land not exceeding one (i � acra ihat immediatey surtounds Nat s ure Is used to produce Income, describe Ihe usa and portion
W Na properry utl�ized m produca income.
��-/�- 0�-yaa --c� �. �/ - da 8�
���� :ASSE OR U E ONIY � d��„ 7��UE TAX� '¢ ASSESSED VALUE � HOMESTEAD�. �`"°',.`NON-RE3IDENTIAL � �"
...�f s.;� .t�:x.f._�`s.y ��{z�"'�'.�- -..�3;i � i ��,VlLLUE� '� eAT:100%OF,�TTV s- :�VALUE `r i i^'�> a'=ti;VALU vi'P.+S �i:
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Land not exceeding 1 (one) acre-immediately �� � ���+,� �x.J,r,F,3' ��? � � c � � _
surtoundingrasidenvalimproveme�ts. ;4-�y ��y�;;,,� s.;c,,a,.;�
Other land �y� � . � �� , � `'
,.,� �:3.: .. .- ..:.:
Tctal land (17ne 7 pfus line 2) �3�
Dwellin 4 ��'.i^, ryirz� � y�y� Y i��
Residen6alimprovemenLSOrMnually 9 ( � �s.�>+ f�' K:,.v c",aa `.:�:,
Pssessed Mobile / Manufactured Home ��-5-3 � fi4�: '
r '=— . i .
Garege �5� ..1.. .r. .�., ..,�,T•-'�+�
`_^<.-•-_lf"'�..'+¢i: .:a .
OJtrel improvements (6) _ _ :, <;;>�� •`:.� `�
Tatal improvements (line 4 through Ilrre 6) �7� .
7dal value (line 3 plrs line � �g�
I bflreby Certi(y Ne ebove iS Wa, Corted, and � SignaN�e ofAssessor ' Data Wpned
complate. .
Varifyinp actlon - SlgnaNre of Auditw Date signed
20 _ Pay 20 _
Lesser ot 1l2 Hwnestead
Valuatiop or $35,000
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