Homestead_Atchison�.°�"a
:�4 t CLAIM FOR HOMESTEAD PROPERTY TAX
= CREDIT/STANDARD DEDUCTION
` j s��e F«m sa�a �RS i�o-0i�
Prescribed by the Depanment of Local Government Finance
INSTRUCTIONS: See ieverse side lor liling insWC�ions.
� � `�'' ':(�?:= ._ - . _ : . �' /1 - .�- CERTIFICATION
FORM
HC10
YEAR �
�
il
�(we) • certify lhal on tst y_,,Ma"f 20_
I(We) oaupied as our pnncip lace of residence the tollovring described real property (or which a Homestead Property Tac Credit is hereby Gaimz
❑ I(VJe) owned ❑ Are buying under wntracl JUL 3 � ZQ02
�,4ave a beneficial interest in the entiry that is liable for the pmperty taxes on the property and that owns the property�s buying under a,contrac
If buying on contraq, Fee Simple owners name
Remrders olfice where contrad is recoraeA
Record numher � Page
:�. .. _ _ � . . ----": . : v
:..':: .. ��. �-'t _::':;..�.�..� .-�-•`.> . -.�r`--�'�-PROBERTYDESCRIP.TION:;-�. ._:... . �. - - ..-... �_.. .
Counry Tavnship Tacing dislrict (city, fowq fownship)
P n ber al desc`ri-pltion ]/�y /� I Is the property in queslion:
— s W v� 1 � �A ❑ Real pmOertY ❑ Mobilo Homo (I.C. 67.7-1)
I( any pottim ol Na resitlentlal sWCWre w tha land not exceeding one (1) aue Ihat immediately sunounds Ihat swcmre is used to produce income, tlescribe Ihe use anA portion
of ihe properry utiliZeA to produca inwme.
- /�-c�� -��Q - 000. � 9�- D��
";.=-'i k� s- �..:' �" _' �,•PROPERTYOWNEDBYCLAIMANTIN�OTHER'COUNTIES �''t °t'f'n' ,� -tt -
County To.vnship Caunty To.vnship
I hereby ceAify the above statements are We, correct and complete. Sig ature o i- �
�ress num6ei and streef, ciry, s(ate, ZIP cade) -
3 �. -4 +'�� 4�"' s` �'�' ` .- �; R s� - �- 7RUE TAX - �ASSESSED VALUE HOMESTEA� � / NON RESIDENTIAL �
��?� � � ,� ASSESSOR USE ONLY . `k . ,-s � VAI.UE„ � .� � AT 100°/a�OF�.TN �. � VALl1Ef �' �� =VALUE �--_"`'K -'{
,io:.� �. e,.,at .r-?�.t.... ._ C-� . »�d .. .. ., �.,-.. .. ....-. ,�.�.. _�... -.... ...r-,z._ r�t�.-a
Land not exceeding 1(one) acre immediately � fi f w�' ,� -* -�- �-_ .
surroundingresidentialimprovements (�� ' `� �,,`,,�.;,= ����'
: �ck �
Otherland (p� �;4:�.._'
_ - az
Tdal land (line 1 plus line 2) (g�
Dw011ing (4) �.,2 { �'�.,,. `s�tja r3 �"�+.� n...
Residential improvements '- * L�r-�xr a. i.Y [� 's
,�,, t�`�. ',,,-`S`' s,{ ''z.`°�.�`^' s?
Garage (s) 'Ne i�i : k-kr�..' �...'�k�.�;-4 : � �'
,.: -
; -:iu:'
Other improvements (6) - - ;; f� >.�,
Tclal improvements (line 4 through line 6) (7�
To[al value (line 3 phs line n (g)
I hereby ceAify the above is We, cortecl, and Signamre oi assesmr Daie signed
complete.
Verifying action - Signature aflwtlitor Date signed
20 _ Pay 20 _
Lesserof 1/2 Homestead
ValuaGon or 56,000
S
SgnaWro ot PnOitor ��� , 1 I uate sigryqp � I' 0 r�
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