Homestead_McCulleyCLAIM FOR HOMESTEAD PROPERTY TAX
-° " CREDIT/STANDARD DEDUCTION
t•u � Sfate Form Sd73 (RS / 10-01) �
PrescriDed by fhe DeparhneM d Local Govemment Finance
INSTRUCTIONS: See reverse side /or (ling instructions.
FORM
HC70
YEAR
c`^' )(�'�,/ldl�(`� A�i. �— vr`lr (X( �� I 1 f �� N y
I e � certi that on the 1sl da of March. 20_
I(We) occupied as our princi I place oi residence the following described real property tor wf � a Homestead Property Ta< Credit is hereby daimed:
❑ I(VJe) owned ❑ Are buying under contract �
� Have a benefidal interest in ihe entity thal is liable (or the properry taxes on the property and ihal owns lhe property or is buying under a conVaU.
I( buymg on conVaU, Fee Simple owners name
Remrders olfice whma contraG is recorded
County
Tawnship
1�'"�7 � U..i �%d �./ V �
V
H any portion of Ne residenUal atructure w Me
of Na properry util¢ed tn produce incoma.
�
0
.
Recard number
Page
Tating disUitt (tiry, fown, lownship)
Is the property in quesUOn:
❑ Real property ❑ Moblle Homo (I.C. 6f.1-'� .
) ave t�et immeEiatety wrrounds that sWCWre is used W produce income. desaibe �he use antl portion
- �a. y3a -�.zi
�-- --�° �m- _ --x.�r�••�.�} T - --� ,- - _ , -, __ ._ _.. _ — ---- . - - • -
+.�a*+f �:E�_�s�+-£�� �-a�` -�'2��--.r��. P,ROPERTY.OWNED;BYCL'AIMANTIN!OTIIERiCOUNTIES��=;'.ic'',�`�-:�.'�5.,5��.„"�"�`�.'�.__°,'�u'S��"'�E
County To.rnship County Twvns�ip
I hereby certify the above sfatements are We, coned and complete. Signature ot daimant
'ress (number end sbeet, ciry, sfate, ZIP code)