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a� �°a CLAIM FOR HOMESTEAD PROPERTY TAX
z��: CREDIT/STANDARD DEDUCTION
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� INSTRUCTIONS: See reverse side /arlilrng"ins(ructions.
FORM
HC10
VEAR
I(We) __ // (�/ certify tha%n the 7 si day of March, 79_
�e) o pied as our principal place of residence the following described real property for which a Ho stead Proqgrty ja` C�t is hereby daimed:
I( e) owned ❑ Are buying under contraci �l � '�
AUDITOR
❑ Have a beneficial interest in ihe entity ihai is liable for the pmperty taxes on the property and that owns the property or is buying under a contract.
� � CONTRACTRECORDED '
It Wyirg on contract, Fee Simple owner's name � � � � _ -
Recortler's oflice where mntraci is recorded Record number Page
' PROPERTY DESCPIPTION
TownShip Taainy district (
number /�.-� Legal tlescnption �j•
��- W��%� o� � ���o� � Oa n �I
wrtion of the residential stmcture or the land not e.ceeding one (1) aae thai immetliarety surrounds that structure is used to produce income, describe ihe use and portion
�roperty utilized to produce income. ,
�l -�7�lG-OXlO -OOD• �/ 7 Q�Z�
PROPERTY OWNED BY CIAIMANT IN OTHER COUNTIES
r Township Counry _ Township �J
certity the above statements are true, correct and complete.
(number and stree( tiry, stafe, Z/P code)
ASSESSOR USE ONLY
Land noi exceeding 1(one) acre immediately
surrounding residential improvements.
Oiherland
Total land (line 7 plus line 2�
Dwelling
Residential improvements
Garage
Other improvements
Total improvements Qine 4 through line 6)
Total value (line 3 p�s line 7�
I hereby cenify the above is irue, correci, and
wmplete.
Veritying action - Signature of Autlitor
79_Pay79_
Lesser of 7l2 Homesiead
Valuation or 52.000
TRUETA7( v ASSESSED
VALUE VALUE
(�)
(2)
(3)
(4)
(5)
(6)
(�)
(8)
SignaNre o� ASSessor
STANDARD
S
HOMESTEAD I NON-RESIDENTIAL
VALUE VALUE
Date signed
Date signed
aditor I Da;e signetl I
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