Homestead_Williford (2)CLAIM FOR HOMESTEAD PROPERTYTAX p'J
CREDIT/STANDARD DEDUCTION ���'
SteM Fam 5173 (R6 / 4-03)
Rwrnbed by Cn Departmmt of Lxal Govemment Fmarwe f1�
v
INSTRUCTIONS: See �ercrse tldo kr�np ia07�cCOnt
FORM YEAR
HC10
-�i
��e) � lhat on the 1sl day of March, 20_
I(We) occupied as o rincipal place of residence the following described real property for which omestead Property Tac Credit is hereby daimed:
❑ I(VJe) owned ❑ Are buying under conirad
' Have a benefidal interest in the entity Nat is liable for the property taxes on Ihe property and �hat owns lhe property or is buying under a wnVaG.
If buying on coniraG, Fee Simple owners name
Recordels ofim whwe contraIX is rewrded
County
Pt���i= Da�y��I'
I( any portion of �he residenllal sW cture w Ne
of the property uUl¢ed tn produce income.
not esceedinp ane (1) aue lhet
RecorO number � Page
Tming dislrict (ciry, fown, fownship)
Is ihe property in question:
' ❑ Real Droperty ❑ MobJe Homo Q.C. 67.1-7)
iunds Ihat sWCture is use0 to produca inmme. deuribe 1he use and portion
�^4 £� F ����"�'�����{"��� �TRUET��� ASSESSED�VACUE �HOMESTEAD� � NON�tESf�E� L ' -�•�
`� yASSESSOR�USEONLY- r 4
� �:.� �-�3T.5S?�'o'9#lt3tT�r�.4'.-'.�P����� ��"•+VALUE..- .s�hs AT 100°/a�.OF�TiV,y �;rVALUE� ���-,c��V� y��
land not exceeding 1(one) acre immediately ���� f^.5 ������ '�'�
surrounding residential improvements. (� � ?}�"`�����.....="��.� �
Other land A�� ����-'`�`���
(2) �iS��,-.u�-3
:#..,,�., �:
Tdal land (Gne 1 plus line 2) �3)
�,.,. ,sn �-=�.v�_; �
Dwellin9 (4) ��`�s+�'"'�r�.-g'��y�k-.n-�.
�Residential improvemenfs or MnuaOy ��"�e4��'-�'`�"'`���'���'
Aasessed AAodb / ManufatLued Hmie Garage (5) ���. ° - �- �-?'�����?
�
� `s.�`� .�"t'
Other improvements (6) � . °v
�'z�., ��#:���
Tolal improvements (line 4 through line 6) (�)
T[1a1 value (line 3 plus line � (g)
I hereby cerfify ihe above is We, corred, and Signature of Assessor Date signed
complele.
Verifying action - SignaNre o(ALOilor Date signeA
20_Pay20_
Le;ser of 1/2 Homestead
vauamn a 535.000
3
Signature o( Aud'Aa � / �/ � � ,( � �/ � Date sgned