HomeMy WebLinkAboutHomestead_FischerCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stete Form SA73 (R6 / 4-03)
Presaibed by ihe Deparbnent of Local Gwemment Finance
INSTRUCTIONS: See reverse side lor (ling instn�ctions.
• FORM M YEAR
HC10 �
�
=����L=c�"�_» �kX_.:_h�'i� �: >-�'4�� ;�%�?+`��1: K�IF.IGATION STATEMENTf: � ?a�.j,?'�h-"- -.:�ii#''��i�`` : ` " -
��e� certify that on Ihe 1 st day o( March, 20_
I(We) occup' as our principal place oi residence lhe following described real property (or which a Homestead Propeny Tac Credit is hereby daimed:
❑ I(VJe) owned ❑!ve buying under contract
, Have a beneficial interest in ihe entity that is liable (or ihe property taxes on the property and that owns the property or is buying under a wntract.
If buying on conVad, Fee Simple ownefs name
Remrders affice where cantraa is recor0ed
County
Toxnship
mwn,
Rewrd number � Page
/f /o' y�vls��
� � /� �V`-' �j ,QJ / � Real praperty ❑ Mob'le Homo (/ C 67 1-�
It any portim of the resiEential sW qure w Ne land not exceedi one (1) aQe that immeaiatety surrounds that st Cure is used to D�oduca income, dewihe 1he uu and portion
ot the properry utilizetl W produce i�ome.
a(o-�--l-�b-�oo -�o.y.�5�-oa.►
�_�'.�.'-''v��'—yzhus`.�'"5y^ia',-^r'C'.a�-�r�a.�+�. I- 2'rst y »,� - +—i...t.� � .. � . ,�;., ..T a: .
��-i `�'-�ASSESSOR�IJSE ONLY ����"' � TRUE TAXH �� ASSESSED VALUE HOMESTEAU�� � NON;RESIOENTIAL �
�����,-p „�.•{C�v,�..,x_ R�r�,:^Y-�},�°, a�'�ix, y��V/LLl1E�„� y AT 100%'AF:TN� �.VALUE� ��_y.�•v`�.�`d�I�VALUE��tx��q�
Land not exceeding t(one) aae immediatety � ,,,r�", -5:�����
__ , :,...�_,..,, �.... .,
surtounding residential improvements. ��� . ��� ��`-'�:
.= .�� ..��qK•e �
Other land �``"�'��� --`�
i2) '� �"°'��
�� ��.
,.p>:�:-` -
Tdal land (line 1 plus line 2) (3�
�� ��� � Y ��
Dwelling (4) �„
�Residentiel improvemen4s or Mnuaity ��'�� iP' �
Assessed Mobile / Manufadured Home Garage �5) ���'� ��,�
'�'�,t:-= ' ��H$'� �'
+,�sX'�'���?:
Other improvemenls (6) ��"�'�"' "^ "�
';s;��-. "�-,�r� '+?=
Tdal improvements (line 4 through line 6) (��
Tdal value (line 3 plia line n (g�
I hereby ceAify fhe above is We, correU, and Signamre o(nssessor oate signed
complete.
Verilying aclion - SignaWre otAuditor Date si9ned
��'��`-°��.��z����`;�+��j���STANOARU`DEDUCTION�ALCOWANCE� ���'u�•�'�`�-"'�,�'t'�.'F��'t;��"�=�'�-��'
20_Pay20_
Lesser of 1Y2 Homestead
Vaivauon w 535.000
S
Signatura of Auditw ' Date signed