Homestead_Harmon�a ��n � CLAIM FOR HOMESTEAD PROPERTY TAX
s� CREDIT/STANDARD DEDUCTION
.� State Form Sa73 (R2 / 5-92)
s � �
INSTRUCTIONS: See reverse side loi /iling insUUCfions.
FORM YEAR
eoi16�12 u • a r:
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.e) d��Q_�J�f`C� �� ���
real property for which a Homestea r Cred s�ri�imed:
� I(We) owned ❑ Are buying under coniract -
❑ Have a beneficial interest in the entity that is liable for the propeAy taxes on the property and thai owns the property or is buyin9 under a contract.
.�,. . . . ,.. .. �CONTHACTRECORDED "_ ,�...- .�.�� ��-_,:. . �.:,.,°_;�.. �. , '.....�..,,,
If buying on contraq. Fee Simple owner'S name
Recorder's ottice where contract is recorded Recortl number Page
TownShip
i�J�J'l.l)l-ILl1�� ��
If dny portion of the fesitlential SlNtture or Ihe land not
of Ne properry utilized ta produce income.
E
� �PROPERTV DESCRIPTION ' -
" Taxirg � trict (dry tmm. rownshrp)
�
�
one (1 � aae that immedia[ey surrounds that structure is used to produce
-�� O�. �DG- Gt�U. j
- PROPERTY OWNED
TownShip
certify the above statements are true, correct and complete.
� Op�—/
��
describe Ne use and ponion
� ASSESSOR USE ONLY - TRUE TAX ASSESSED MOMESTEAD� � NON-RESIDENTIAL ��
� � - VALUE VA6UE YALUE . VALUE .
Land not exceeding 7(one) acre immediately � �� �
surtounding residentiai improvements. (�) • '
Otherland (p) ° - '
en �
7otalland (line 1 plus line Z� (3)
Dwelling (4) � - �
Residential improvements
Garage (5) -
Other improvements (6) -
Total improvements (line 4 through line � (7) �
7otal value (line 3 p�s line � (g)
I hereby Certify lhe above is Irue, correti, and Sgnature of Assessor Date signetl
mplete.
ying action - SgnaNre of Autlitor Date signed
79_Pay19_
Lesser of t/2 Homestead
Valuation or 52.000
5
Sgnature of Autli;or � I Date sgned
_ _ '.�