Homestead_Ziebell (3)' ,i
•"a� CLAIM FOR HOMESTEAD PROPERTY TAX
�+ � CREDITlSTANDARD DEDUCTION
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State Fortn 5473 (R2 / 5-92)
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INSTRUCTIONS: See �everse side /or liling instructions.
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FORM YEAR
HC10
I(We� �(`� �� w '�� t�-'�- certi Z� t t st � df�.1�JP,�19�
I(We) occupied as our principal place sidence the following described real property for which a Homestea r pe�$ �i�s hereby daim
� I(We) owned ❑ Are buying under contract P �� 1(,�
� Have a beneficial interesi in ihe entiry that is liable for th � � and that owns the r��or u i under co act.
� �\� �•TY,� ��-
If buying on contract, Fee Simple owner's name � CilBs
Recortler's oHice where contract is recorded �"�' "' �� Record number Page
. � r, . (l•od r."°�' , . _. � g , �, _ . - . �
Coumy ,� �
Parcel yn ,m,ber �y Legal description �
'�I y -l�/'YX d -�O
If any portion of t�e resitlential stmcture or �he land not exceeding one (7 � acre thai immediately surwunds Ihat strucNre is used to produce income, descnbe Me use and portion
oi the property utiGZed to produce income.
a lo- � a-o �i - 3o`t - oo �. zgo - 6 a�
. ASSESSOR USE ONLY �-
Land not exceeding 1(one) acre immediately
surrounding residential improvements.
Other land
Total land (line 1 plus line � �
Dwelling
Residential improvements _
Garage
Other improvements
Total improvements (line 4 through line �
7otal value (line 3 p�s line 7�
1 hereby certify ihe above is true. correct, and
complete.
Vorilvim anion - SianaWre ot Auditor
TRUE TAX
VALUE
(�)
(z)
(3)
14)
(5) �_
(6)
1�)
(8)
Signamre ol Assessor
ASSESSED
VALUE
19_Pay19_ I
ser of 1/2 Homestead
Jal ation or $2,000 $ �
HOMESTEAD
VALUE
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NON-RESIDENTIAL' �;
VALUE
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� • Date signeC
Date sgnetl
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DajC sig� ���
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