HomeMy WebLinkAboutHomestead_HigaCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stata Form Sa73 (R6 / 4-03)
Prescribed by the Department of Lacal Govemment Finance
INSTRUCTIONS: See iaverse side /or (ling insfi�ctions.
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FORM 'N� YEAR _
HC10
a
I (We) � � `"U /1^Z�f/ � � �/�1 9'l7 � /�`C�C� cert t wy�i th�lst d�M ch,
I,�(W�e) occupied as our principal place of residence the f Il i described real prop y for which a Homeste�p94y T�e �� is e b aimed: -
� I (We) owned ❑ !ve buying under wnlract �� � ��n�
` Have a benefidal interest in the entity that is liable for the property taxes on the property and ihat owns the prope s y ti r a wnVact.
If buying on conVad. Fee Simple ownets name
Recofdefs otfice where contracl
Counry
Tovmship
dislrict (ciry, tawn, township)
Rewrd number
AUDITOR
Page
Parcei num6er Le al descri tiyi{i �s � �
� q yerty in questi .
�O S' O �// /o � p O L<J � 3—,3 /� eal proDerty ❑ M b'la Hwno Q C 67 7d)
If any po�ion af Oie resitlenUal sWCture w Ne land not exceeding one (1) aae that immeeiatety sunounds that swcture is usetl to D��uce income, desaibe the use and poNon
of Ihe property utilized tn produce irrcome.
�,�.�Y � aG - ��-0.3- ,3� - c�. �rG -q�i
County
Tavnship
I hereby certify the above sfalements are We, coned and complete.
County
dres (number aiW 51 ciQ; sfafe, P cade) �� �(// ��� U I
��I/.3 0�, 5,� /G.i l�wens� ; IIP_ �h
20 _ Pay 20 _
Lesser ot v2 Homestead
vaivauon w E35.000
ollwdilw
5
signed
7_� �%—D