Homestead_GoingsCLAIM FOR HOMESTEAD PROPERTY TAX
CREDR/STANDARD DEDUCTION
Slete Form 5173 (RB / 1-03) .
' Resalbed M tM DepaNiroirt d l.or�l Go�emment Finance
� iNSrRUCnoNS: saa �o�.�ao �s a r�,p tRm„ar�a
FORM YEAR
HC10
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I(We) certiN that on the 7st day of March, 20_
I(We) oaupied as our principal place of residence Ihe following described real pro rty (or which a Homestead Pr��a{�'�s hereby daimed:
❑ I(We) owned ❑ Are buying under contrect �;��ON COUN7Y AUDITOR
` Have a beneficial inleresf in the entity that is liable (or the property taxes on the propetty and fhat owns the property or is buying under a wntraU.
II buying on conirad, Fee Simple ownefs name
Recorders afice where
Tamship
�6(�g17w9�_V ^� , ��p — l_Y� I Legal deu �pG n (1 /1 /
lN ( �� ' A 11 1�
.l�G(liI/
H eny ponion ol ihe resitlantlal atruchire w the land na axceedinp one (1) aae that
of the property utilzed tn praduce income.
Counly
I hereby certify the above statements are We, corted and complete.
(num6er arwl streel, ciry; atate, ZIP code)
Record number
(tiry, fown.
Pa9e
Isthe p�ope�rty,in/G�uestion:
% I_�KABeI Droperty ❑ Mobile Home (/.C. 6f.1-� .
r
��unds that swar�re is used b praduce inmme, descrihe Me use and portlon
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County
Signature otclaimant
Tawnship
20_Pay20_
Lesser of 1/2 Homestead
V9uaUOn a f35.000
$
SignaWreo(h ` ^(� „(� I / IDates'rc�etl� ( O �
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