Homestead_McClellan (2);� CIAIM FOR HOMESTEAD PROPERTY TAX
' CREDITISTANDARD DEDUCTION
t � Sta�e Porm Sa73 (R6 / 403;
Prescnbetl by the Departmem of Local Govemment Finance
INSTRUCTIONS: See revcisc sidc loi /ilinp Insl�ur.fir�ns.
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FORM YEAR
HC10
�.:•v:,f _.� ' -' . _ ... �GERT7FICATIONSTATEMENT" '=',� ^N-�.� A.��.:','..;'...�% .
��e) ^ � � certify that on Ihe�ls6day o(March, 20
I(We) occupied as our principal place of residence Ihe follo ' descnbed real property (or which a Homestead Property T�c Creditis h�ereby daimed:
❑ I(VJe) owned ❑ Are buying under contract �1
, Have a benefidal inierest in lhe entiry that is liable for the property tazes on Ne property and that owns ihe pro�or � b�jn�der a contract.
If byvig on conUacl, Fee Simple owners name
Recordefs olfice where conired is recordeA
Couniy
Tavnship
�� -viy.�y � t rt.�. �.� at-
portion o1 the resEential sWCWre w the Wnd not excaetling one (7) acre that
property utilizeE to produce ifxAme.
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Record number
Page
E5CRIPTION�...._ . ..z._ , _- , - - .. °`--..-�: ...._� .
Taing tlislrit� (city, fowq township)
Is e pmperty in queslion:
�� ❑ Real pmDerty ❑ Mobile Homo (LQ 6Lf�7)
iatety sunounds that swcUUe is used b protluce income, describa the use and ponion
County
I hereby certify the above statements are We, conect and complele. '9 �
Addre s uplr�pr and strcet, city, state, ZIP�e), � n � .1 ��
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�� 4 i"� ASSESSOR USE ON�Y . � � TRUE TAX ASSESSED VALUE .� HOMESTEA� � � NON-RESIDENTIAC,
? `„a.�A?`r,t� .�r :. F E ........ - - ' VALUE AT 700%OF.�.TTV - � VALUE' � . i: VALUE �. �
Land not exceeding 1(one) acre immediately -';cT:,�c.':��""'': ..
surroundingresidentlalimprovements. (�� . , . � � , �
OWer land (Z) � - � _ , �
Tctal land (line 7 plus line 2) (3�
Dwelling (q) ,. � � . � - _
_ '�"o�i.�::-: -:i� �=- i-� �. `�
Residential improvements or Mnually - -' �`�" °� • • _ _
AssessedMObile/ManuFacturedHOme �5) �:��-�*.�-e��;:>;,,-,•_z-�::... _.
Garege
Other impravements (g) �
Total improvements (line 4 Ihrough line 6) (71 I
Total value (line 3 plus line 7) (g�
1 hereby certify the above is true, conect, and Signamre o� asseswr oa�e signed
complete.
Vedfying actbn - Signature of Puditor Date signed
20_Pay20_
Lesser of 1!2 Homestead
va�uauon or $35.000
Signawra o(AUditw
_ =�.STANDARD.DEDUCTION
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