HomeMy WebLinkAboutHomestead_HiteCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Slate Fam 5173 (R6 / 4-03)
ReacnbeE by the DePeMron1 d Locel Govemment Finar�ce
INS7RUCT10NS: See ra�avOe atds Ilpr �rp iy07�fiony
.
iG FORM
HC10
YEAR
i cwel �� h�0i�1 / �� �en;y �hs � P�nl 1, d006r Ma«n. zo_
I(We) occupied as our principal place of residen e ihe (ollowing descnbed real property for which a Homestead Pro�pejrty Tac Credyt is hereby daimed:
❑ I(We) owned ❑ Are buying under contract (/'� aG �f �'
'� Have a benefidal interesl in the enliry that is liable for the property taxes on the property and Ihat owns tB�'.�fi�e�ilis��Yyi�1��iliF�a wnUact.
I( buying on conirad, Fee Simple owners name
Remrders o16ce whme mniraq is recorded
County
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T��O
Le9al descriptbn
T�ing dislrict (d fo iP)
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Is Ne
Record number � Page
�U��✓' i/ i�U � I �e�ProPa�b ❑ MabilaHOmoll.C.bf.f-7)
H any portion ol Me residentlal sWCWre w Ihe land not exceeding ona (7 � aae Nat immediatety wnounds tha� sW cture is used b produce inwme, describa Na use and portion
ot the proPertY u�7ized ta produce inmme.
al�- I�1-a I- aop -oo�� ,-��� -oa J
County
I hereby certify the above statements are W e, corred and complete.
cit}; upafe, zlPCOde)
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County
S, yqature o� ciaim t
7"-� �
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° SN y �
Township
�zr�`} r �"�°�'��"�������"�'�� z�"�' �"TRUET JC �� �ASSESSED VALUE 3 ti.- � ` ... "".,
�-+`ASSESSOR�USEONLY '���Y'c"�+s�"' � .t �H�MESTEA� ° tNON=RESIOEtJTIAL�h
x-i�.'d`-`�.���wE'PizY�!'�n':3.._..T °�"����`°a.�� ��VALUE��; � AT 100%'.OF.3:.T.rV.:1 +�..�.VALUE+� �T��'a���ALUE''„�=''��
Land not exceeding 1(one) aae immediatey f ii �,�" #,��z`�c��3�`� ��.�
surrounding residential improvements. (�� � t �.: `��'',�,.�i���`����z'
Otherland (Z� r���"��`.-°,'�c���.-�'�^"Y �
� �',: ..: s?
Tdal land (line 7 plus line 2) (3�
1 T�.J'7W�"�cM� �°"��,:��
Dwelling (4) '-y��+ "�'� ���s��§
�
�ResideMiellmprovementsaMnuaOy �:a^:'�"'��^� ..Q��'�'`����t'�
Garage 5 ,a-.c � ''�'"''�°v.,`f"`'+�-� "i
ABSeaeed M068B I MeflufeWlrBd Hmie ()
�` ''srr+:i"�.�r'?����
4.z �.�'.�,-r^�.v .' S_}
Other improvements (g) �� yy#, �". � �^n
i k.,.:�.:f-� �,
Tdal improvemenLs (line 4 fhrough line 6) (�)
7dal value (line 3 phs line n (g�
I hereby ceAify �he above is We, corted, and Signature ofl�ssessor Date signed
complete.
Veriry�ng action - Signature of Auditar Date signed