Homestead_Hasselbrinck (5)r;� CLAIM FOR HOMESTEAD PROPERTY 7AX
• CREDITISTANDARD DEDUCTION
\ � S�ate Form 5773 (R614-03)
Presrlibed by the Department of Local GovemmeN Finance
INSTRUCTIONS: See revasc side Ioi lilinr� insfruc(ir�ns.
FORM �'' YEAR
HC10 �
�����
�-_ -� ' . .. . _...3..: . .
��e1 certi(y that on the 1st day of�vtarch, 20_
I(VJe) occupied as our rincipal place of res nce the (ollowing described real property for which a Homestead Property Tarfyqdit is he��daimed:
❑ I(We) owned ❑ Are buying un r con�ract N
O �(a� ,a
� Have a benefidal interest in the entity Nat is liable (or ihe properry taxes on lhe properry and that owns the propertyoS�buyiR�unb�r ���i�
If buying on conirod. Fee Simple owners name
Remrdefs olfite where contrad is rewrded
Counry
Twvnship
- (f:
Record number
IPTION�:-. ` .- ' = .^.
district (ciry, mwn, rowpshiP) /�
Page
�..:i= �� . .
Parcel(�y/y/^j�) O� `�./ L I C n Is Ne property in queslion: �
VV � U/ y yl� 3-3-�a � Sf7e � � Real 7ra e ,. n
p rty ❑ MobilbHOmo /C.61.f-
I( any portion ot the resiEenGal structure w the IanE not exceeding one (1) aae Ihat immediatety sunountls Nat s aure is used to protluce income, desaibe the use and ponion
of We properry utilizetl to produce income.
-/r 63-/oo-o6a.o/�
P,'������i'�ASSESSDRLSEONLY� ���TRUETAX ASSESSEDVALUE -HOMESTEAD � NON-RESIDENTIAC,-
:,?/ir`�`?'{� ; ^._c z..s:= �. �.VAI.UE �AT7006�AF�TTV . -�VALUE £,. .�.-VACUE::`•':�
land not exceeding 7 (one) acre immediately -, <.' �^": �'�'=-- -" � =��
surroundingresidentialimprovemenis. (�� . -. ' .. .�
Other land (p) .. . -
Tdal land (line 7 plus line 2) �3)
Dwelling (4) '-..
Residentiel impmvemenLS orMnually , ,-.s�"� ' , , : `_ " r"�:.'
Assessad Mobile I Manufactured Hane Garage �5) t� �����:; .
Other improvements (6) �
Total improvemenLS Qine 4 through line 6) (7) I I
Ttial value (line 3 phs line n (g�
1 hereby certiy the above is true, conect, and Signawre o� wssesmr Oa�e sgned
compiete.
Venfying action - Signature otAuditor Date signed
. = =-.STANDARDDEOUCTIONALLOWANCE`_
20 _ Pay 20 I
Lesser o� 1l2 Homes;ead 5
vauanon or 535.000 �
I Date sign� – /� —�/
t