Homestead_Anderson (3)ai. ^•o
'� CLAIM FOR HOMESTEAD PROPERTY TAX
;��'� CREDIT/STANDARD DEDUCTION
� State Form Sa73 (R2 / 5-92)
�'.
uu
INSTRUCTIONS: See reverse side lor tiling inst�uctions.
FORM
HC10
YEAR
i �we) � — • " vi certify.ihai on t�t�y;Df Ma� 1�_
�) occupi as our principal place t residence the following described real property for which a Homestead Property r ite� her8�•� ���ep
I We owned P a- �'�
( ) ❑ Are buying under contract
❑ Have a beneficial inierest in the entiry ihat is liable for the property taxes on the property and that owns ihe property or i�in�r�ler���ntPaci.
-. CONTRACT RECORDED
If Wyirg on contract. Fee Simple owner's name
Retorder'S oflice where contrac� is recorded
Record number � Page
� `- PROPERTY DESCRIPTION � ' �
Caunry � - Township . T�mg distri (o , 1 vqi n, towns rp) /"� _
, �� \ vl! 9s.GJ
BH1eeJf�w�qr^ oQ� �` ' ^ O �egal description �
�/`� ( `�
If any portion ot the residenfial struaure or Ne land not ezceetling one (7) acre that immetliatety surmunds that strucWre is used to produce income, describe the use and ponion
ot Ne property utitizetl ro protluce income.
Counry
��-���0?7`=
Township
a - Qoo. 35�s�- a� �
OWNED BY CLAIMANT IN OTHER COUNTIES
�eby certify ihe above siatements are irue, correct and compiete. '
Atltlress (number arM street ciry, sfate. ZIP wde) �
�P,P / l�i7k4s�A fT b'.P9NCl,! /N. 471
ASSESSOR USE ONLY
Land noi exceeding 1(one) acre immediately
surrounding resideniial impmvements.
Oiherland
7otat land (line 7 plus line Z�
Dwellin9
Residential improvemenis
Garage
Other improvements
Total improvements (line 4 through line �
Total value (line 3 p�s line �
1 hereby certify the above is true, correci, and
comptete.
V?�irg action - Sgnature ot Auditor
79_Pay79_
Lesser of 1/2 Homestead
Valuation or 52,000
Signature of Audi:or
,`.�'�`+�.oe---�
TRUE TAX
VALUE
1�)
(z)
(3)
(4)
(5)
(6)
l�)
18)
Signature ofASSessor
�
of
ASSESSED I HOMESTEAD I NON-RESIDEN'flAl
VALUE VALUE VALUE
Date signed
Dare signed