Homestead_Kiesel (15)\
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form Sa73 (R2 / 5-92)
INSTRUC710NS: See reverse side /or7iling instructions.
.-.
FORM
HC70
YEAR
6�
���Ne) � /,;,J�a .C_ ��� 0 R certify that on the 7 si day of March, 79 / U
�'e) occupied as�our principal plac t residence the following described real property for which a Homesiead Pmperty.Tax Credit is hereby daimed:
LI I(We) owned ❑ Are buying under contract . �
❑ Have a beneficial interest in �he enii�y thai i5 liable tor Ihe property taxes on ihe property and thai owns the property or is buying under a contraci.
� CONTRACTRECORDED -
If b�ying on contracl.�Fee Simple owner'S name , �
Recortler's oHice where mntract is recorded Record number Paqe
County
TownShip
DESCRIPTION
town, township)
d
Parcel number Legal description
0o�1-0i�7S-Oo� Pb h�� � W a�-_3-) � S.a3 �,
It any portion of the residential strucwre or Ne lantl noi exceeding one (7) acre that immediatety sunounds that structure is used to produce income. descnbe Ne use and portion
ot the pwperty utilized m produce income. •
- /�D - CV�/. - 77� -
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE. VALUE VALUE
Land not exceeding 1(one)�acre immediately
surrounding residential impmvements. (�) �
Otherland (2)
Total land (line 7 plus line7� (3)
Dwelling (a)
Residential improvements �
Garage (5� -
Other improvements (6)
Total improvements (line 4 through line b) (7)
Total value (line 3 p�s line 7) (g)
I hereby certify ihe above is true, correct, and Scgnature of Assessor Date sgned
complete.
�tyi(g action - Signature of Auditor Date signed
79_Pay19_
Lesser of tl2 Homesiead
Valuation or 52,000
STANDARD DEDUCTION
E
ot Auditor _ � Date sgnetl