Homestead_Fox�._•�.
e! ' Y CLAIM FOR HOMESTEAD PROPERTY TAX
i��: CREDIT/STANDARD DEDUCTION
., ��.,,�� Slate Form Se73 (R2 / 5-92)
�si�
INSTRUCTIONS: See reverse side lor liling instructions.
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FORM AR
HC10
: • . - � � C TIFICATIUN STATeMENT � ' " - - -
I(We) certify_ihat on ihe isi day of March, 79 —
I(We) oc ' d as r pri i al place of resitlence ihe following desai ed real property for which a Homestead Property Tax Credit is hereby Gaimed:
� I(We) owned ❑ Are buying under coniract , . _ ,
�.�ave a beneficial interest in the entity that is liable for ihe property taxes on the property and lhat owns the �tAp�uyjpg�q¢p� contract.
It buying on wniract, Pee Simple owner's name
RerArder's oflite where ContraCt i5 reCOrded
_ CONTRACTRECORDED
PROPERTY DESCRIPTION
Gounry , , , Township � TazingdistryCi!
r I� ber Leqal tlescriptio
-DO D-0
It any portion of the resitlential structure or the land not exceedirg one (7) acre
ot Ne property utilized to produce income.
, , I LU 1 V 1�7JJ
ecord_n4mDe1 �
iR/ /f7
. fownsbip) _ _ '
�C b' �'/v /-y�/�CJ C�,�
surrountls that siructure is used m produce income, e ihe use and portion
�9��!��O =GY}O. ��o -Cb?S
PHOPERTY OWNED BY CLAIMANT IN OTHER COUN
Counry
I hereby certify the above statements are irue, correct and complete.
\�
I'`ress (number arW 31reet, ury, state. ZIP code) _
ASSESSOR USE ONLY . � TfiUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
. � VALUE VAWE VALUE VALUE
Land noi exceeding 7(one) acre immediately - �
surrounding residential improvements. (�) � ' �
Otherland (2)
Tmal land (line i plus line 2� (3)
Dwelling (4) , -
Resideniial improvements
Garage �5) '
Oiher improvemenis (6)
Total improvemenis (line 4 through line � (7)
Total value (line 3 p�s line 7� (g) �
I hereby certi}y lhe above is true, CorreCi, and Signature ot Assessor Date signed
complete.
Verilying action - SgnaNre oi Auditor Dare signed