Homestead_West (3)�/,�� ; CLAIM FOR HOMESTEAD PROFERTY•:TAX., r� .
! �A�� CREDITISTANDARD DEDUCTION � : � =��
♦ � vt:nc F«m Ss73 (Rfi / 4-03; ..
Presaincw Uy ��e DeDartment of Local Govemment Finarice ' '� � � � �
INSTRUCi IONS'See reversc sidc !nr Iilinq n:s(mr.(innti. � � � - '
_ _ ' L- : - ., . . � . .. . . . .
FORM
HC10
YEAR
"':.� " __g(:tK1lYIl:AilUNSIAIEMENT% �X°.1' . `'°.y; -'
._ �..-i ...e.: ' ar.._.'�_a.. res=:�.- ....-'i° � ' `�' ' o �
I(VJe) �' '' ify that on the 1st day of March. 20_
I(We) occupied as u rincipal place of residence the (ollowing described real property for which a Homestead Property T�c Credit is hereby daimed:
�I (We) owned � ❑ Ne buying under contract - � ' �
Have a beneficial interest in the entity tha� is liable for the property.tazes on lhe property and lhat owns lhe property or is buying under a contraU.
I( buying om m�tracl. Fee Simplo owners name
Recordefs olfice where wnt+acl is recorded
Record num6er Page
i:i�'.d�..x:.:��'r:.d '�FY-n.s.r!«F _.an.:"=:S�x�w[tpr'.>'��.-s;::P,ROP,ERT.Y�.DESCRIP.TION�r;:.";'-.:� `c.� . r�._-�u::i� . , �xt'. ��'.. _-�:.' ir.:..-..
Counry - 7oy��ip ' Tating tlislritt (tiry, town, township)
ParIce`l Inumber al de5triplion Is �he property in queslion:
V U�_G ���_� I ¢al property ❑ AUbile Homo (LC. 61.7-7)
I' ony yartion of Ne resider.tial sWCiure or the Wnd nW ex e ing one (1 aae l�sl immetlialety surrounds ihat s Gure Ls used tn produce incwne. Cescribe the use antl ponion
ot tha property utilizM la produce income.
� �- ia -� � _ �Yoa - 6o y. a,�a - oa �
�*.'': .F �-�G��>���ii,,�-it , +�--:�.s`=ra.�PROP,ERTY;OVIINED`�BYCLAIb1A►1T-IN�OTHER`COUNTIES�`;,,,.�i?: s`.'��..��:-z„ �r.-`���'..-:':..�.
�• .t..
County ' Toxnship County To.vnship
1 hereby cerliry the above statem>nls are We, correcl and complete. Signature ot claimant
�dress (number end street, city, stafe, ZlP code) - - �
� � ��� c� ' �`r '`y`S`�; � � 3�xP�..°`�� �''6 TRUE:TAXr s'�� ASSESSED.1/ALUE HOMESTEAD 5` ��'" � NOIJ�-RESIDENTIAL"�` - - �
�S[.'r�-'�.� ��:.A`SSESSO�US�ONLY�a'�ri�..s,viFi1':�3 ��.::,=VAI.UE�� a.�: 'AT 700Yo'OF.TN° �• e^':�:VALl1EStih`' F�9 s}S .� s � .t ��
,.�.ys.-r. :c , � .c,.�?c._._ ...�-�...: !?.�p,.? y..,.aVALUEl�s_��, -`
Land no� exceeding 1 (one) acre immediately - - ' ' :�'�ii`�tia�r '� �s� � �*.�:µ o, °'-��:
surtoundingresidentialimprovements.� ��� :���'�*e�'�'�'�;t�e„�,'r'�'z'�
Otherland � }`���{'"� �`��"6i �
(z� �� r;�,.�. "v.. . � �
TUaI land (line 1 plus line 2) �3�
. � �`'1tJ jr i �.Y i
Dwelfing (4) 3'J t��?"t"�2_ �.�._r, }�
Residenliel improvements or M�uaNy �t r� ��f ��z,d.-r-� ��� ..'�e..��,
0.ssessedMobile/Manuf�acturedHome Gara e .:r��`'^�a'i.Jk,Ts''F��-kr.x`r?�y�>y
9 (5) 3 ,.. *a �,'ar ��'yx/4•;',:�
� �.,-d,
Otherimprovements . (6) �';;���`�''�5�^:
� «>ii5.':�-�*.� �`
Tdal improvements (line 4 through line 6) (7)
Tctal value (line 3 plus line n (g)
I hereby certify �he above is We, corteG, and Signamre ot nssessor oate sgnea
complete.
Veriryi�g action - Signature aflwtlitor Date sgned
Y-'�."�:�'V.`�`: *. . `�.�_'��.:_`T "1- .--�:.``.�'S.r.�'3 . .STANDARD:DEDUCTION'ALLOWANCE�:..x�asrFa.a�.�'.��..s;u -. �. v=:e'z'Fe�"�� �� ��''
20_Pay20_
Leiser of 1l2 Homestead
vaivaaon or 535.000
S
Sgnature of Audflor ' Da1e signed