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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Form Sa73 (R2 / S92)
FORM
HC10
YEAR
uva � nuu � wrva: aee reverse mae �ur nnny ms�mcuons. . g .
R
� CERTIPICATION STATEMENT ,� �.
I(VJe) —� ���or�he 1��� of March, 19_
I(VJe) occupied as our principal place of residence the follo �n described real properry for which a Homesie d Property Tax Credit is hereby claimed:
❑ I(We) owned ❑ Are buying under contract � �
'Q Have a beneficial inieresi in the entiry that is liable for the properry taxes on the property and that owrGj � ntract.
. GI���tv f I
CONTRACTRECORDED
It buying on conVact, Fee Simple owner's name . �'
Recordets otfxe where canVact is recorded Recortl number Paqe
� PROPERTY DESCRIPTION
Counry Township ' a�dng disirici (dry, town, township)
parcylnur�{ber O Le�e�ptian � � � 1 _ —
LIIJ 5
If any ponion ol the residenlial swcture or ihe land not exceetlirg one (7) acre that immetliately surtounds that suucture is u to produce income, describe Ne use arM �on of
Ne property utilized ro protluce income.
c�-/ -O/-o30O ' a� �/d�0 -O
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township County Township
S tur of daimant
�reby certify the above statements are true, correct and complete.
Aadress (number and streeG city, state, ZIP code) '
ASSESSOR USE ONLY TRUE TAX _ ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (�)
surrounding residential improvements.
Otherland (2)
Total land (line 1 plus line 2) (3) '
� Dwellin9 (4)
Residential improvements
Garage (5)
O[her improvements (6)
Total improvements (line 4 Ihrough line 6) (7)
Totai value (line 3 plus line 7J (8)
I hereby certify the above is true, correct, and Signamre of Assesor Date signetl
complete.
Verifying action - Signature of Autlitor Date signed
�' STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead y
Valuation or S2.000
Signature of Auditor Da[e signetl