Homestead_JochimCLAIM FOR HOMESTEAD PROPERTY TAX FoRM
YEAR
CREDIT/STANDARD DEDUCTION HC�O � C�q �
State Form Sc73 (R2 / 5-92) _
INSTRUCTIONS: See reve�se side Ior7iling instructions.
CERTIFICATION
�) � � . certify ihat on ihe 1st day of March, 79 [ `75"
) occupi as our princip place of residence�the following described real property for which a Homesiead Property 7a�c Credit is hereby Gaimed:
�,✓I (We) owned ❑ Are buying under coniract . _
❑ Have a beneticial inreresi in the entiry that is liable for the property taxes on the propeny and thai owns ihe property or is buying under a contract.
� � CONTRACTRECORDED. � .
It buying on contract, Fee Simple owner's name . � -
Recorder's oNice where coniract is recorded Record number Page
Township
Taxing di5lrict (city, town, township)
P�e�umber 'O � 7a!_ OD I Legaldescription// / `n� J� �� / � _ / z . /. /! �
S U / / ./
If any ponion of the residential structure or the land not exceedinq one (t) acre that immetliatety surmunds that structure is used to produce income, deuribe Ne use and
of Ne pmpeny utiiized m protluce inmme.
— //�Q/-
ASSESSOR USE ONLY ' TRUETAR ASSESSED HOMESTEAD � NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding t(one) acre immediately
surrounding residentiat improvements. (�)
Oiher land (p)
I
Total land (line 1 plus line Z� (3) .
Dwelling (4)
Residential improvemenis
Garage (5)
Oiher improvements (6)
Total impmvements (line 4 rhrough line 67 (7)
7otal value (line 3 p6s line � (g)
1 hereby certify the abOVe is true, correci, and Signawre of Assessor Date signed
complete.
✓ug aaion - SignaNre oi Auditor Da;e signed
L
19_Pay79_
Lesser of V2 Homestead
Valuation or 52.000
STANDARD DEDUCTION ALLOWANCE
S
I Date signed
�'-. /J�-�c,.s ia - �6 -