Homestead_Campbell[tf R`��
e� ''' i CLAIM FOR HOMESTEAD PROPERTY TAX
i%�� CREDIT/STANDARD DEDUCTION
�%�� State Porm 5�73 (R2 / 5-92)
�ao
INSTRUCTIONS: See reverse side (or liling instructions.
FORM
HC10
YEAR
e)��_� � 1 U__��J �_ 1 V�-- certify that on the 1st day of March, 19_
�:) ccupie as our pnncipal place of residence the following described real roperty tor which a Homestead Pr Gaimed:
/ ���
i(We) owned ❑. Are buying under coniract
Have a beneticiai interest in the entity that is liable for the property taxes on the property and �hat owns the property or is buying un e contract.
� -. � . CONTRACT RECORDED � �
If buyirg on contract, Fee Simple owner's name � . /1UDITOR .
Recorder's office where contract is rewrded Record number Page
Counry
Township
DESCflIP'fION �
Ta�cinq diSlriC� (di
0
,�.� '�
If any ponion of
of Ne property i
'-�UUI - -
structure or the lantl not exceeding one (1) aae that immediatety surrounds that structure is used ro produce income, describe Ne use and
�ce income.
-/d�c��-le� - GYJ/. �%?- Do1�
PROPERTV OWNED BY CLAIMAM IN OTHER
Township County
certify ihe above statements are ime, correci and comp�e[e.
humberandslreer�itv,state,ZlPwdel_ . _
ASSESSOR USE ONLY
Land not exceedinq 1(one) acre immediately
surrounding resideniial improvements.
Oiher land
Total land (line 1 plus line 2�
Dwelling
Resideniial improvements
Garage
Oiher improvements
Total improvements Qine 4 through line �
Total value (line 3 p6s line �
I hereby cetlify the above is tme. wrrect, and
complete.
v_�ityirg action - Signature of Audiror
79_Pay19_
Lesser of 1/2 Homestead
Valuation or 52,000
TRUE TAX
VALUE
(�)
(2)
(3)
(4)
(5)
(6)
l�)
(8)
Signamre
ASSESSED I HOMESTEAD
VALUE ' VALUE
STANDARD DEDUCTION
�
NON-RESIDENTIAL
VALUE
Da:e signed
Date signetl
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