Homestead_Wethington (3)e.� '��3 g CLAIM FOR HOMESTEAD PROPERTY TAX
a��: CREDITISTANDARD DEDUCTION
.�.,;� State Form Sa73 (R2 / 5-92)
iai�
INSTRUCTIONS: See reverse side lorliling instrucfions.
STATEMENT
FORM
HC10
�
I iWe) / (,//U • _ _ certity that on the 1st day of March, 79_
�pi as our principal pla f residence the followinq described r I roperty for which a Homestead Property Tax Credii is hereby claimed:
J I(We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for ihe property taxes on the property and that owns the propqflrprjp bgying;yaAer�tract.
If buying on conVact, fee Simple owner's name
Recorder's oNice where contract is recortled
Counry
JI'I l
If any portion ot
ot Ne pmperty i
CONTRACT RECORDED
Township Taxinq tlist ct ( ry, �ov�a.... , mp) �
_ oo Legal description
I
�ntial strucmre or the land not exceeding one (1) acre that immediatety surmunds that struc[ure is used to produce income, tlescribe ihe use antl ponion
protluce incame.
� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES " �
Counry Township Counry
.�•eby certify the above statements are true, correct and complete. Signa re ot daim� �i
vri
ddress (numberantlstreet, ciry, sfafe, ZlPCOde)
Go/ l� �'
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately
surtounding residential improvements. (�)
Otherland (2)
Total land (line 7 plus line Z� (3)
Dwelling (4)
Residential impmvements �
� Garage (5) �
Oiher improvemenis (6)
Totai impmvements (line 4 through lina 6) (7) I
Total value (line 3 p6s line � (g)
I hereby certi(y the above is irUe, correc�, and Signature of Assessor Dare signed
complete.
Ventying action - Signature of Audi;or Date signed
�
e
79_Pay19_
Lesser of V2 Homestead
Valuation or 52.000
5
SgnaNre of Autlito� � � / _ � \ ' - ^ /� � - I �a�e s�gneo
/\_ Cl f \ �/ \/ � /
^I��_I1! b I � __�__ -�—(—