Homestead_Smith (9)�E R`I}�Q - : ' .
e/ =" g CLAIM FOR HOMESTEAD PROPERTY TAX
=;1�'� CREDITISTANDARD DEDUCTION
�. ; � State Form Sa73 (R2 / 5-92)
��u
INSTRUCTIONS: See reverse side lor filing instruc(ions.
FORM
HC10
i'
YEAR
� � CERTIFICATION STATEMENT - ' � -
� �We) WV�., _ _�{,�,_ _ _ . certify t���st d � rc 79
�I) pied as our pn �ypal place of residence the following described real pmperty for which a Homestead P e daimed:
� I(We} owned ❑ Are buying under contract . ..pgpy 1 p'1996
{fflN1 1lJ
❑ Have a beneficial interest in ihe entity that is liable for ihe property taxes on the property and that owns the propedy or is buying under a contract.
It buying on comract, Fee Simple owner's name
Recordefs oNice where mnVaa is recorded
County
Township
� lJ•r hYT7 0 oI legal description ��
�
If any ponion ot the residential structure or ihe land no� ezceetling one (7) acre
of the pmpeny utiiized to produce income.
T-D�y�9-96 • --
DESCRIPTION
� — � ) �
surmunds Nat structure
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
� certify the above siatemenis are true, correct and complete.
(number and slreef. aty, sla(e. ZIP code)
ASSESSOR USE ONLY
Land noi exceeding 1(one) acre immediately
surrounding residential improvements.
Oiherland
Total land (line 7 plus line �
Dwelling
Residential improvements
Garage
Other improvements
Tota� improvements (line 4 th�ough lina �
Total value (line 3 p�s line �
1 hereby certity the above is true, correct, and
complete.
.V;d{y��g aclion - Signature of Autlitor
19_Pay79_
Lesser of 7l2 Homesiead
Valuation or 52.000
TRUE TAX
VALUE
(�)
l2)
(3)
(4)
(5)
(6)
1�1
(8)
Signamre ot Assessor
S
Record number Page
ro produce income, describe the use arW portion
ture of claimant
z N d `�°7GL�
ASSESSED HOMESTEAD
VALUE VALUE
NON-RESIDENTIAL
VALUE
Date signetl
Date signetl
Signatureo�Autlirot / ��. � � p\ � 7 ,, , �� /}— �a�esigneg, �7
w r/ `''L �J 1 �AR ....— � � � / �
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