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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form Sd73 (F2 / 592)
INSTRUCTIONS: See reverse side /or liling instructions.
FORM
HC10
YEAR
�) - certify thai on the ist day of Mamh, 79
) occupied as our principal place of residence the following described real pr rty tor which a Ho/¢�+estead P�rop�(rty� Credit' he y claimed:
LJ I(We) owned ❑ Are buying under contraci {( ,�� � �J.��
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❑ Have a beneficial imerest in the entiry ihai is liable for the property taxes on the property and th oa( � w���,the pioperty�or is buying under a coniraci.
- � CONTRACT HECORDED � � � . .
II buying on contratt, Fee Simple ownefs name _ .
Recordefs oXice where contrect is recortletl Rewrd number Page
� � � "� PROPERTYDESCRIPTION = ' �
County�, �� \ TownShip Taxing dis �c iry, Iown. township) ,
�S ) t� �.J �
Parcel num r Legal description %�)
O — — � � /
It any ponion of the resWential stmcture or the land not exceeding one (7) a e that immedi e surrounds that structure is usetl tQ prody �ce ir�qq�ne, describe Ne use and portion
of the pmpeny utilized to produce income. �G/ ���Q _ Q�(�j/��,0�\ l\.. � 1,5 �
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�G - /��3 -�o.� - � aS � ,
� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES '
County Township . Counry Township
eby certify the above statemenis are true, correct and complete. Si9namre f ciaimam
Address (numbei and sneef. dry, state, ZlP cotle)
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDEN'fIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately .
surroundinq residential improvements. ��) "
Otherland (2)
7otal land (line 7 plus line Z� (3)
Dwelling (4) � -
Residential improvemenis �
' Garage (g)
Oiher improvements (6)
Total improvements (line 4 th�ough line � (7)
Total value (line 3 p�s line 7� (g)
I hereby Certify the above i5 irue, correci, and Signature of Assessor Dare signed
plete.
�ing action - Signature of Auditor Date signed
STANDARD
19_Pay79_
Lesser of 1/2 Homesiead
Valuation or S2,000
SgnaNre,olAudiior I Date signed
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