Homestead_Whitehouse�� CLAIM FOR HOMESTEAD PROPERT.Y�`TAX .
CREDIT/STANDARD DEDUCTION
•t /.. Sta1e Funn V 73 (R6 / d-03: . ' .' , •
Prescribed by me Deparment of Local Govemm�ni Finanu:' �� � ' �
WSTRUCiIONS See revcrsr side, (or hLny u tibm�(iom;� � ��
, ...�J
FORM
HC10
YEAR
i;`i .y_,,,,. . i`�' � �?_-�'�S. -.. ,. . ;��� e;: ;;;.;.:x �,^CERTIFICATION STATEMENT;- ..:�.i'-��- . �. : _.` �.:•�-,`� � .
�(We) ' ' � � -certiy that o�n thR 1Sf d�dybf'Mdreh. 20_
I(We) occupied as our pri i al place of residence the following described real property (or which a Homestead Propg—rtyy yT�ac Cre� is hereby daimed:
� I(VJe) owned Are buying under contracl ' '' • � � O'�O�y
C/
' Have a benefidal interesf in the enliry ihat is liable for ihe property taxes on the property and that owns the�pFB�dt,ddZpm�qjqg q�ntract.
,,,���aNzsr:. if;t.:�F3.c``i�'.q^��''�„""�42�s.:s.,�.tt,,,�C:cr.r . .♦ ,.T-' zni';�. �,� .:��,.: . '
�'4 , - �'-=:CONTRACT!RECORDED�;.�. . t
It buying om m�tmq. Fee Simplo ownefs name • ' �
Recorde�s oRce where coniraU is remrded , � Rewrd number Page
County I Toxnship '
9grc@ n�� � 1 O\ �L g escnption
U�`� F U
11 any ponim of Ihe resitlential s'.ruclure w the tand na �ceeding one (7 )
ef the property uLl¢ed lo produca income. ' _ .
Toxnship
I hereby certify the above statements are tnie, correcl and wmplefe.
p
Tacing_dislriCt (Nry, town, tawnship) ' .
./ /^ I Is ihe vmperty in questian:
;� / �� ❑ Realpropefty ❑ MobileHOmo(I.C.6f./J)
immediately wrrounds ihat swaure is used b produce income. describe the use antl ponion
County
���'�r.4'+i.i°' �'����"�"'��" _" �:�'�'� �. TRUE7AX ASSESSEDVALUE'ST HOMESTEAD�� ��3 +✓�NON-RESIDENTIAL�T`
7�`���ti�,xA�S�SES�OR US�ONLY ���- �"`�r_.: ���VALUES tvs ��,AT 100%`OFTN� �.''";VALUE Y��f. rEa�",� t"� o' VALUE�� T��;{��
Land not exceeding 7 (one) aae immediatety � `" `' � ,`� �.� °�`'.'Y`'-�: -,� r °'`:
surtoundingresidenlialimprovements. (�� �:';�'_:�,'�.1y,',����.-;.-?;r�`.�
� . . �,�'.�c.n, tiF. Y �. �...
Other land � � � (2) ,. 3�a -�.���g
-:,-..:�au•,e��'S
Tolal land (line, t plus line 2) � . . (g�-
. . . � x . , s y � �.. . � .. �
Dwellin9. (4) - �� �,� �2 y.. h , �.
Residen6al improvements orMnualy � �"`� g"�"`�' `����"'�`t;
�lY 3i `45-''��""�x rT'"�� �- �'
hssessed Moblle / Manu(aciured Home Garage (5) r� _.: .�ct�r,. ��+�` a,,,'-.
-eL ,. �.-�iyz 7s ...:
. .�nt�:�"$�.5'•�A :.
Otherimprovemen�s (6) L� j "�='
R-..�T a.rx.A_�'
Tual improvements ((ine 4 fhrough line 6) (7)
Tdal value (fine 3 plus line n (g�
I hereby certify the above is We, conecl, and Sgnature of Assessor Date signed
complele.
Vrritying action - Signature oflwditar Date signed
20 _ Pay 20 _
Lererot 1i2 Homes�ead
vawaLOn or 535.000
�
Signaturooflwddw ' r �\ ^ �1� IDate{sigietl � �_ Q
� � ��vwa. , :�i
t