Homestead_Williams (21)ai^� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
1�E��• State Form Sa73 (R2 / 5-92)
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INSTRUCTIONS: See reverse side !ar liling instructions.
FORM YEAR
HC10 �
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e) certify that on the t day of March. 79��
�\occupied as our principal pla e of residence the following described real propeny for which a Homestead Property T�iyQ�by ��ys
(�Ne) owned ❑ Are buying under contract AUDITOR o�
Have e beneticial interest in the entiry that is liable for the properry ta*es on the propeny and that owr.s the property or is buying under a contract.
CONTRACTRECORDED �
II Wying on conlraci. Fee Simple owner's name
Recorder'S ofl�ce where contraa i5 �ecorded Record number Page
PROPERTY
County
:ownship)
Parcelnumber Lega' cnp�ion
�Iq -o3a�� C�} �t� R-�-io .��
If any portion of ;he resitlential stmcwre or the tand not e.ceeding one (� 1 acre ;hat imme0�ately surmunds that stmcture is usetl ro protluce income. tlescribe the use and portion.
of the pmperty milized to protluce income. -
Counry
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTII
TawnShfp County
certify the above statements are true. cortect and complete.
Address (number ana sneei. ciry. state. ZIP code)
Township
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding 7(one) acre immediately I, ' I I
surrounding residential improvemenis.
Otherland (p)
Total land (line 7 plus line Z� (3) I I
Dwelling (4)
Residemial improvements
Garage (5) I I
Other impmvemen;s I (6)
7otal improvemenis (line 4 thiough lina � I(7) I I
Total value (line 3 p�s line 7� I(8) I I
I hereby certify ihe above is irue. correc�. and Signawre of nssessor I Date signed
complete.
Veritying action - Signa;ure of Audiior Date signetl
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19_Pay19_
Lesser oi 7l2 Homestead
Valuation or 52.000
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ALLOWANCE
Date signetl
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