HomeMy WebLinkAboutHomestead_Poyner`�f �'�ir4
a�/ ", CLAIM FOR HOMESTEAD PROPERTY TAX
. CREDIT/STANDARD DEDUCTION
7.� �::
�.,�`� State Form 5a73 (R2 / 5-92)
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INSTRUCTIONS: See reverse side for liling instructions.
STATEMENT
FORM
HC10
YEAR
I 1We) _uJ_ .____ _ v __ __ V L certify� that on the 7 st day of March, 79_
,e) occupied as our principal place of residence the following described al property for which a Homestead Property Tax Credit is hereby claimed:
IG � IWe) owned ❑ Are buying under contraci =� -� ��-;:
R :. 4�� .�� �;.
❑ Have a beneticial interest in the entiry ihai is liable for the propeny taxes on ihe property and that owns the propertgor is �buy(�g under a conti8ct.
If 6uying on contract, Fee Simple owner's name
Recorder's oflice where Contracl is recorded
Counry
Township
Legal description
Record
�� .
If any portion oi ihe reSWential stmcture or the land not eeceeding one (i) acre that immediately wrmuntls �hat struciure is used ro produce income, descnbe the use antl portion
ot the propeny utilizetl to produce income.
_Q1(io / 7 / 7 '
Coumy
��
eby certify the abo esta�
A�tlress(numbe�ands(reet ry.
! �
PROPERTY OWNED BY CIAIMANT IN OTHER COUMIES
tru0, corretl $qd tomplete. � I Signawre o( claimant
ASSESSOR USE ONLY � TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE� VALUE
Land not exceeding 1(one) acre immediately
surrounding residential improvements. (�)
Oiherland (p)
Total land (line 7 plus line 2� (3) .
� Dwelling (4) �
Residential improvemenis
Garage (g)
Other improvemenis (6)
Total improvements (line 4 through line � �7)
Total value (line 3 pUs line � (g)
I hereby certify ihe abOVe i5 true. CArreCi, and Signature oi Assessor Dare sgnetl
complete.
Veritying action - Signature of Auditor Date signed
�
19_Pay79_
Lesser of 1/2 Homestead
Valuation or 52.000
�
Signature ol Autlilor / ��� � _ \ ^ /-� '� _ / I vacsq� �� � r '�
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