Homestead_Hirsch (2)�E R�3
a/-� � CLAIM FOR HOMESTEAD PROPERTY TAX
;'�� CREDIT/STANDARD DEDUCTION �
.�;��� Sfate Fortn 5a73 (R2 / 5-92)
�eu .
� INSTRUCTIONS: See reverse side lor liling inst�ucfions.
e
FORM
HC10
YEAR
)_ � C�(��( 1/ 1 . - certify.ihat on ihe lst day of Mamh, 79
�) ccupie as our principal place of residence the fo o �ing described real property tor which a Homestead Pmperty Tas Credit is hereby Gaimed:
�(We) owned ❑ Are buying under con(ract . , � �� � ��
❑ Have a beneficial interest in ihe entiry ihai is liable for the property taxes on ihe property and that owns the property m nd ra
• _�CONTRACTRECORDED � �
It buying on contrap, Fee Simple owners name . . - .. ' � �
Rewrder's oftice where comract Is recorded pecor numberAU DITO �.
� PROPERTY DESCRIPTION �
Counry _ . - Township . Tazing district (ciry, town, rowns � _
P ¢ ' er Legal descr'
-0�8� -oo � �. �, (.� D-3-//� D 2c�-
I; any portion o( the residemial stmcwre or the land not ezceeding one (7) aae that immediatey surmunds that structure is usetl to protluce income, describe Ne use and portion
of the property utilized to produce income. r .
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
�by certify the above statements are true, correct and complete.
Address (number and sfreet ciry, state, ZIP code)
RR�- 1 Pox s�s �x�- 3ea
Signature�dai�nt � ��
' � ASSESSOR USE ONLY TflUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
� VALUE � VALUE VALUE VALUE
Land noi exceeding 7(one) acre immediately
surmunding residential impmvemen[s. (�)
Otherland (p)
Totalland Qine 1 plus line 2� (3) -
Dwelling (4) �
� Residential improvements .
Garage (5)
Other improvements (6)
Total improvements (line 4 fhrough line � (7) .
Total value (line 3 pbs line 7) (g�
I hereby certify the above is Irue, Correct, and Signamre of Asseswr Date signed
camplete.
(� vig action - Signawre of Audimr . Dare signed
L
19_Pay19_
Lesser ot ll2 Homestead
Valuation or 52.000
Signature
5