Homestead_SchnarrCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Forth 5473 (R614-03)
Prescribed by the Department or Local Government Finance
INSTRUCTIONS See reverse side fnr lilinn mo,,,6.—
FORM YEAR
HC10
I (We) l-A 1E�'��i:, /r certify the lr the 1 l dOy March, 20
1 (We) occupied as our principal place of residence the following described real property for which a Homestead Prop y Tae r ereby claimed:
❑ 1 (We) owned ❑ Are buying under contract /
Have a beneficial interest in the entity hat is liable for the roe taxes on the roe and that ownsthe o is . � undaracontract.
ty property nY property rty Pr pertly, - , -
'� Gla�nfJ r` ^1 • - • n1Tn3 I
CONTRACT RECORDED:'`}'12a'
If buying en contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
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�P.ROP,ERTY:DESCRIPTION'3 ?t- �'ts5,'�>,�`.�'?E•5�`1t`..['"
County
Township
Taxing district (dry, town, township)
Par I nu elO
_�
L g desert tion I S_
Is the property n question:
/ V a
OWN Y '�'
MEWI''i`�, '- r`5
property ❑ Mobile HOme (l.C. 61.1 -7)
H any portion of the residential structure or the land not exceeding one (1) ace that immediately surrounds that structure Is used to produce income, describe the use and Portion
of the property utilized to produce income.
NON = RESIDENTIAL` 'a
If OPERTY,OWNED;BY`CLAIMANT,IN:' OTHER' COUNTIES';
County
Township
County Township
hereby certify the above statements are true, correct and complete.
i ature of claimant
ress (number and sshnsef, city, stale, ZIP code)
'4 a l ` dJn }
OWN Y '�'
MEWI''i`�, '- r`5
"TRUE TAX
ASSESSED VALUE
"AT
HOMESTEAD'
NON = RESIDENTIAL` 'a
.iASS,gES50 USE, -
a� .
_VAI:UE r-
MILVOFT.IV'
xL•
VALUE
`"VALUE
Land not exceeding 1 (one) acre immediatetyr.-
,�'#�,'y`F$
surrounding residential improvements-
Other land
(2)
s�
''•~
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential impmvementa or Annuagy
Assessed Mobile / Manufactured Home
Garage
(5)
a
MOWN A. 3,
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature oflutditor
Date signed
Signature of Auditor
20_Pay 20_
Lesser of 112 Homestead
Vauatton or 535.000