Homestead_DavisCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STAIdDARD DEDUCTION
se� ro� sr�a (Ri i 5-os�
Pras�ed by Te Oeu�6rient ol Lool Gwemmad Frw�w
lNSTRUC710NS: See iaverso side (w filinq instrucGons.
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FORM
HC10
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i lwe� � l � t,�:-� � l�X �L� Lx� �roy a�c «� a� i� mY �r ►,��zo_
I(We) pied as av prmdpal place M resider�ce the fo9owirg described real property for whidi a Hanesfead Pm�TmiCSdA rs�{�ereby daimed:
� Ll1U/
) owned ❑ Are buymg un0a contrad
H a bar�efidal interest m the entiry tl�at is liade far the property tazes m the popaty and Ciat owns Me propertyf'�a5 buSt�,'�nder a mntract
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tt Mryr9 on �trad. Fee Sir�le ow'�a reme
f�,ude/s d6ce whae canVad'u recada0
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Courty ' Toxr6hp.
Reoord numbx � Page
Pa�mi nmiba �ry b Na poperty in queffim:
�i l� I'�� �3-3—►1 '! [�rL► ❑�� ❑�b�v.�.�,.,-n
n ery pamn ot u,a re�a�a� �,m,a u u,a �d „a �nB o� (i� ave mM:nv�ey a,�� mm �,mre o uaed ro v�:�mRb. das�m n,e �aa and �m�
a ure ao�ey wr�d m p�oa,� ��.
� � a �- ��-►3-�,�-�.o��-��
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. .•�� .�,::`. . .. �:�,.';�PROPERTYOWNED�BY�CUIOIANT�d�OTHHiCOUNigSt�� .���" '.,ti?l4.'�ns,-!ar +r},�'+„�,?+;
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Counry Tumship Counry Twvnship
I fiereby certify ihe abwe ShaBertienTS ma true. carred and car4le�. �+re d damat
(nurber eM street oA: ste�. ZIP mCe)
r �' �.�. : f -�,:� ��i` ` TRUETAX � ASSESSm�VALUE HOYESTEAD �. �o-' y NON�tESIDFli71AL�;
yt,, ir.t? ;ASS£SSORU�OqLY 'h.. �'`i., �.. V/LLUE i �AT;700%OF7TV3 a'1?tYVV�� 2$zJ - rsn�Pl"�A,�; VALIIEtiA.'��. �x«=i�."vl'
..Landfroteueedingi(one)aaei�ately (�) .^ yh�'�{{i�`"`'�sit�.a�y7Pr3�A"+;}�
surtaad'ug residential impovertients. x,+� lt "a+>i�?':�+ vS. a� :]`S?u�i�a st
Other land 2 � ` �. -
(1 �,,,rr;
Tdal land (!me 1 plus fine � (3)
q+ `t,�eif�4P GL.a l�i � i��,{'f
Resdentialvn{uvvernentswMrwally ���9 (4) "�<�.,"�'s��'i'.�.v!�:.$t���f'�:.4'`�,��/�?�
AssesSed Alo6de / Alanu(arLSed Home ��e (5) �k°�'�r�,` ���' �� y�k3. �'nL��L;.R,?;r
C v.
omer'unprovar�ents (s) • :..� � �
-, o!.
Tdal'vrryrwarents (iire 1 Mvou� 6ne 6) (�)
TUaI value (I"ure 3 pka Gne n (g�
I hereby certify the a6ove is true� cortect. ard Siar�sa of wsassm. Dam signea
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�%rilyinp a�tion - Si�aune af AudOOr Date signed
20 _ Pay 20 _
Lesser d 12 Hareslead
Vah�atian or f:i5.000
Si�ahae d Ndlar
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