Homestead_JerniganN,c m•�
e� � CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
.�d
S� e .
.�;-��� State Form Sa73 (R2 / 5-92) � .
�iie
INSTRUCTIONS: See reverse side Ior liling instructions.
FORM
HC10
AR
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��e) �,J,�(,�(,�JL �- c.tti. _� __ � certify that on the 7si day of March, 79
) occupied as our principal place of residence the followi e real opeAy or which a Homestead �Property Tax Credit is hereby claimed:
�We) owned .❑ Are buying under contract I . .
❑ Have a beneficial interest in the entity that is liable for ihe property taxes on the property and that owns the property or is buying under a contract.
CONTRACT
It Wying on conlraci. Fee Simple owner's name
Rewrder's o(fice where coniract is recorded
PROPERTY DESCRIPTION
County Township _. , Taxirg 5-. ry, ow towi
/"�r(f,yj\r7�.�,'�e_O^S / � Legaldescriplion
\./�JJ ✓
tl any portion ot the resitlential stmcmre or the IarM not ecceeding one (7 � aae ihat immediatety surrounds ihat structure
of the pmperty utilizetl to produce income. . �
- / / % CO � `7(.Cl ' L.Cl.7. d
PHOPERTY OWNED BY
Township
(r�entsfl� trye, cor ect and complete. �
ASSESSOR USE ONLY
Land not exceeding 7(one) acre immediately
surrounding residential improvements.
Otherland
Total land (line 1 plus line 2�
Dwelling
Residential improvements
Garage
Other improvements
Total improvements (line 4 through line �
Total value (line 3 p�s line �
I hereby certify Ihe above is Irue, correct, and
complete.
�ying action - Signature of Auditor
19_Pay19_
Lesser ot 7/2 Homesiead
Valuation or 52.000
Sgnature of Autlitor
MANT IN OTHER COUNTIES
Caunty
Signature of claimani
TRUETAX ASSESSED
.VALUE VALUE
(�)
(2)
(3)
(4)
(5)
(6)
P)
($)
Signature otASSessor
S
Page
e
ro produce income, tlescribe the use antl portion
HOMESTEAD I NON•RESIDENTIAL.
VA�UE VALUE
signetl
siqnetl