Homestead_McCoya� ^"�°, CLAIM FOR HOMESTEAD PROPERTY TAX FoRM vEAR
;; �� CREDITISTANDARD DEDUCTION HC�O
.�.,�� Stare Form 5<73.(R2 / 5-92)
�au - ti'7�6 � a �_
INSTRUCTIONS� See reverse side 7o�liling instructions.
I 1we) liL.lR.� l..lJ �/�L / o certity thai on the 7st 3ay of �A�arch, t9
�i occupied as our principal place of residence� e f Ilowing described reai property for which a a�ne,�tead' perty T�dit' �yereby claimed:
I(We) owned ❑ Are buying under contraci � `�-��' byJ
GI,SCN.COUt TV •
❑ Have a beneticial interesi in ihe entity that is liable for the property taxes on the property and that owns the pmperty or is buying und���aT�irtltr ct.
- � -0ONTRACTRECORDED - �
If buying on Contrati, Fee Simple owner's�name .. ., � ' .
Fewrder's oHice where contract is recorded Record number Page
If any portion d
af ihe properry
PROPERTY
Township
fown.
_� I ��o.���,. � � ln/ /(�. 3— %/ �•' ` d R-�-
}ucNre or the land not exceeding one (7) aae that immediatety surrounds thai swaure is used to produce income, tlescribe t�e use and ponion
:1 income. ,
�/in�
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately �
surrounding residential improvements. (�) �
Other land �p)
Totai land (line 7 plus line7� (3) .
Dwelling (4)
Residential improvemenis
Garage (5) . �
Other impmvements (6)
Total improvements (line 4 through line � (7)
Total value. Qine 3 p6s line 7� (g)
I hereby cenify the above is true, correcL and Signamre of Assessor oare signed
complete.
�m� action - SignaWre of Autlitor Date signed
79_Pay79_
Lesser ot 1/2 Homestead
Valuation or 52.000
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