Homestead_Heldt (12)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
State Fortn Sd73 (R614-03)
PresrsiEed by Ne Department of Local Gwemment Finance
INSTRUCTIONS: See reverse side for (li/g instructions.
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FORM � YEAR _
HC10
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��e� � �� � certify that on [he 1 st day of March, 20_
1(We) occupied as our rincipal place o( residence Ihe following described real pmperty for which a Homestead�Pr rty T� �s hereby daimed:
�(VJe) owned ❑ Are buying under contract
�ad �.
��$OrN COUNTY AUDITOR
� Have a benefidal interest in the entiry that is liable for ihe properry laxes on the properry and that ovm p operty or is buying under a wnUact.
If buying om m�tract, Fee Simple ownefs name
Remrders olfice where wniracl is recorEed
+z T ^�, ��+%'�:.tr x c. �.�:�'�.�.�
-� _f �� c^xftc��..5� a.k.. St' �:Mr
Caunty Tavnship
Parcelnumbet
Legal
Tacing distrjc�(city, town, township)
Is Ne property in question:
�6-/9-29-2�-dia./9 -oa_J � ���v�o�ny ❑MObaeHOmolIC6f1-7)
N any poNOn of Na resulential sWCture w the land not e eetling one (1) acre that immetliatety surtounds that strucfure is used W produce income, desfiibe the uu anC partian
of the property ulilized tu produce irm.ome.
t�sEx�- a9 3.� y.,�,�
Rewrd number � Page
����`��5� SSOR� S�ONLY ��_: � ���' �TRUETAX y; �. ASSESSED VALU� ���OMEST ��' �.��N� ESIDENT� ��?:%�
''' �c-s�� k� F VALUE: +�.e-� �AT.t00YeOFTN �^ VALUE£�-� 'r '' 'VlLLUE ���
Land not ezceeding 1(one) acre immediatety _ r�' ,°3ykw ` i.�.-t �,w�,.;
surroundin residential im rovemenLS. (�� Y�iitn� r� ` �`* j��'
9 P ,^r�:�� . P`,.,?4�.':.-;?�'�;�.x
y ��' _
Other land (� ;��- e g r
2 .-:, .,�,�.�� ��
Tdal land (line 1 plus line 2) (3�
v�4..,Y�.�'''�'r4 u '�`z -r� � zy`"v
Dwellin9 (4) - �.,t,;t.�%e�.ax ��"� ��syr.?:s•;i
�Residential improvemenLS orMnually '�=� F^��'�^�'r"�•��`^�'•� �'r'�
Assessed Mobila / ManuFaciured Home Garage (5) cY�g,�"' ,_,,� ��'��'�t +
�-�-,.''��" `���;>.t :�t��-b�;
Other improvements 6 r�-: i� a-<`'-
( 1 ,; ���--a#��
�.I�_1._F]X:3s
Tdal improvemenLs (line 4 through line 6) (�)
Tttal value (line 3 phs line � (8)
I hereby certify the above is W e, correU, and Signature of wsseswr Date signed
complete.
Vaifyim� action - Signature of Auditor Date signed