Homestead_Young (21)d%�"na
. CLAIM FOR HOMESTEAD PROPERTY TAX
s� i; CREDIT/STANDARD DEDUCTION �" �
.
.�.,!• State Form Sa73 (R2 / 5-92)
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INSTRUCTIONS: See reverse side 7oi liling instructions.
FORM YEAR
HC10
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I(We) �O—PifL T c Q��� certify that on the tst day ot March, 19
�e) occupied as our principal place of re dence the follo ing described real property for which a Homesiead Pro/perty Tax Cred�t is eby G ed
� I(We) owned ❑ Are buying under contract �[ ,-.„l—,i ,� i�; �
��.<...., G,�,yTy ,UDITOr�
❑ Have a beneficial interest in ihe entity that is liable for the pmperty taxes on the property and ihat owns the property;ons't�u ing under a contraci.
� � � � CONTRACTRECORDED � " � � . � . - �
It buying on conlracC Fee Simple owner's name . '
Recorder's oHice where cnntract is recortled Record number Page
Parcel
legal description
PROPERTY DESCRIPTION
O/y-�7`f 2'OC1 I
If any portion of the residential stmcture or the land not ecceeding one (7) acre that immediatety surrounds ihat swcture is usetl to protluce income. describe the use and ponion
ot the pmperty ulilized to produce income.
ASSESSOR USE ONLY � TRUE TAJC ASSESSED HOMESTEAD� � NON-RESIDENTIAL.
.VALUE VALUE VALUE VALUE _
Land noi exceeding 1(one) acre immediatety
surrounding residen�ial improvements. (�) "
Otherland �2)
Total land Qine 7 plus line Z� . (3)
Dwelling (4)
Residential improvements _
Garage (g)
Oiher improvements (6) �
Total improvements (line 4 through line �� �(7)
Total value (line 3 p�s line 7� � (g)
I hereby cenify the above is true, correct, and Signamre of Assessor . Dare siqnetl
complete.
Verirying action - Sgnature of Autliror � � Date signed
STANDARD
19_Pay19_
Lesser of 7l2 Homesiead
� V�lyation or $2,000
5
SgnaWre of Autli.or� — . I uate-s-9nea
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