Homestead_WhittenCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
s�ete Pam s47a (R6 � r-m)
PrewiDed by Me Depmm�em dl.otal Govemment finariee
INSTRUCTIONS: See �e�erae std� b�rp iK6ucGona
FORM � YEAR
HC10
��e) certify that on ��l d�Y�f ��. 20_
I(We) a Homestead Property T�c Credit is hereby daimed:
�� I(VJe) owned ❑ Are buying under conirad �I",�{�/�'
, Have a benefidal interest in the entity that is liable for the Oroperty taxes on the property and thal owns lhe pro�e���a�.�de�r�a�e�U.
If buying om m�iraG, Fee Simple owner's name
Remrdefs olfiw where mntraG is recwded
s`{4��'.C�`'arS�?S."� ��.�cC`�..�.�4—'r-g•�Y3
�Y�
County Tamship
Parcel number ^--� Legal description
L°� ��i '.' d L� l( �" �C
If any poAion o/ ihe residenUal sW cture w the land no� ezceetli
of Ue properry uliGzed to produce inwme.
County
Tavnship
Record number � Page
(ciry,.town,
Is Ue property in question:
�teal Dropery ❑ Mobile Homo (I.C. 67.1-7)
(1) aae that immetliatety wrrounds lhat swcfure is used to produce income, desaibe the use antl poNOn
I hereby cerlify the above statements are We, wrred and complele.
=dress(numberandsfreet,cifyistate,Z/Pcode) � �
Land not exceeding 1(one) acre immediatety
surrounding residential improvemenis.
Ofherland
Tdal land (line 7 plus line 2)
Dwelling
�Residanlial improvements w MnuaOy
A�ed �loh�e � Manufa�red Home Garege
Other improvements
Tdal improvemenLs (line 4 through line 6)
Tdal vatue (fine 3 phs line n
I hereby certi(y ihe above is We, corred, and
completa.
Verifyirg aclion - SignaWre of Pudimr
20_Pay20_
Lesser of tr2 Homestead
ValuaTio� a 535.000
SgnaWre of
(�)
IZ)
(3)
(4)
(5)
(6)
(�)
Ie)
Sgnature of Pssessor
County
$
Claimani
�%
Date signed
Date signed
Dale s'gned
� � �