HomeMy WebLinkAboutHomestead_CochraneCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Forth 5473 (R5 / 10-01)
r °u Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions. �^'� 'S' �� T, —•�
(We) \ ,/ V UV--) ( k / (," A k ~2 c0 th uMday of March, 20
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tau Credit is hereby claimed:
❑ 1 (We) owned ❑ Are burying under contract �'1 ///nn/
Have a beneficial interest in the entity that is liable for the property taxes on the property and th t "� the m is buyl4n under a contract.
lit bNI -M':IY AUDI FOR I
CONTRACT.; RECORDED
c
If buying on contract. Fee Simple owners name
Recorders ofice where contract is recorded Record number Page
?`.` `�' .,:�1 �,s�+•trzui c�" ��rtiP,ROP,ERTYjONMEDBY�CLAIMANT IN, OTHER' COUNTIESkaubti;°. -�',.,r,.+�"?� "���' z=r��3<, �4
'_..�PROP,ERTY,DESCRIP.TION'e_
County
Toxnship
Taring district (city, town, township)
Pglge ptynber
es 'p' n � �Q
Is the Property in question:
eat property ❑ tdoMle Homo (LC. & 1J -n .
if any Portion of the residential structure or the land not exceeding one (1) acre that immed N rrounds that s ctun is used b produce income. desrnbe the use and portion
of the property utS¢ed to produce income.
?`.` `�' .,:�1 �,s�+•trzui c�" ��rtiP,ROP,ERTYjONMEDBY�CLAIMANT IN, OTHER' COUNTIESkaubti;°. -�',.,r,.+�"?� "���' z=r��3<, �4
County Tavnship
County Tavnship
I hereby certify the above statements are true, correct and complete.
aura t
Address m r and sfre6ta dy, state, ZIP code) `/a
At
20_Pay 20_
Lesser of 112 Homestead
or $6,000
—J/
VALUE
ry N, OTRUETAX
i;6l ALA
M' VALUE�f� r
AT�100 �
VAL
UEW
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
ice+• Jv. 6 r h
Total land (line 1 plus line 2)
(3)
Dwelling
4
K
<MW—
Residential improvements
Garage
,f. �
iMNJ.__>
(5)
Other improvements
(6)-p
i �.
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 pits line 7)
(S)
-
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20_Pay 20_
Lesser of 112 Homestead
or $6,000
—J/