Homestead_Wilkerson�{ RI�
4� �: CLAIM FOR HOMESTEAD PROPERTY TAX
�,��;; CREDIT/STANDARD DEDUCTION ,
' State Form Sa73 (R2 / 5-92)
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. INSTRUCTIONS: See reveise side (or liling inst�uctions.
FORM YEAFi
HC10
- " CERTIFlCATION STATEMENT - ' ' ' �
I(We)'''��/ , _ certify that on the 1st day of March, 19_
�upie as our principal place of residence the following described real property tor which a Homestead Propeity Tax Credii is hereby daimed:
1(We) owned ❑ Are buying under contract � �
❑ Have a beneficial interesi in the eniiry that is liable for the pmperty taxes on the property and ihat owns the property or is buying under a contract.
I( buying on coniract, Fee Simple owner's name
Recortler's oNice where contract is recortletl
Counry
-CONTRACT RECORDED
PROPERTY
, I Record
r/�� �� 1� I Legai tlescription .
./ 1 `L I r•.)
l J� J��/11" l GIB�n:a Cnt:tl; v t.';ntTna
ot the residential stmcfure or the land not exceeding one (7) acre that immediatety surwunds ihat swcture is used �o produce income. descnbe the use antl portion
y utilized to produce income.
- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Township Coun
certify the above statemems are ime, correci and wmplete. S� ture of clai a[ �� �
W
�number nd sfreeC ary, stafe. ZlP wde)
� � .S' G�/QlNG(.' ��J2iNCLr �6N �No�
ASSESSOR USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residen[ial improvemenis.
Otherland
Total land (line 7 plus line 2�
Dwelling
Residential improvemenis
Garage
Other improvements
Totat improvements (line 4 through line �
Total value (line 3 p�s line 7�
I hereby cenify Ihe above is true, correct, and
complete.
19_Pay79_
Lesser of 1/2 Homestead
Valqation or 52.000
TRUETAX I ASSESSED
VALUE VALUE
(�)
Iz)
(3)
(4)
(5)
(6)
(�I
(8)
Sgnawre of Assessor
DEDUCTION ALLOWANCE
5
HOMESTEAD
VALUE
767a
NON-RESIDENTIAL
VALUE
Date signed
Date signed
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