Homestead_MacMunnCLAIM FOR HOMESTEAD PROPERTY TAX �( FoRM YEAR CREDIT/STANDARD DEDUCTION HC10 SLne Form Sa73 (R6 / 403) � � Presfiibed by the Depanment of Local Govemment Finance ' INSTRUC710NS: See reverse side !or filmg instmclions. �-.f���' x� ���^x�.�-�1"�%;?u.",4.f�-�i` ��r`_^.�' ';��CER FICATION'ST TEMENT-r".�' -r.�'.� i: r- � � u,: 5.r .� #. r.. ii :eY+sa — ...."_ . " '_ .._ _ . .._tv3a �.:,�� . L'i_:-,:; ��;�'r.: a__.....w.� .. �� r.�,�-,Y- .>�,-`:. I (We) �f Mth�14�tl�of March. 20_ I(W oaupied as our principal place of residence the following described real property for which a Homestead�Pyro�,perty Tac Credil is hereby daimed: =(We) owned ❑ Are buying under contract p�! ,Q� . Have a benefidal interest in ihe entity that is liable for the property taxes on the property and Ihat ov�g��i¢b 0.q,11l�der a wnVaU. �n wR I( buymg on conVaq, Fee Simple owner's name Recordefs olfice whera wnUad is recordetl Record number Pa9e � k'� :�`#�� �^'' � Hv � V.fi s` �s� a""`-'-�'} �-r' l Gr.`1`---•• i s�'' .v: .���'„s �,.tt+=::`;�z�.,.<w e-'�w� �'-v�,9 ,�.�PROP.ERTV.OESCRIP.TION��'W'�"„a�-.,,.,�Z'�i,-�'�';f s,�.-`�'�.•.:'F-�y`,Y�;���=.�'t,; Counry Township Tacing �istrict (ciry, fown. townshiP) Parcel number Is the property in �� �— v a 07 a�� I �%'�r'� �10J � 6� 3��V I �eal Droperty ❑ Mobile Homo (LG 61.7-7) If any portion ot the residentlal sW dure or the tand not e:ceeding one (7 � aae Nat immediatey surrounds that sWCture is used to produce income, describe ihe use and portion of the propery utilized m produce inwme. /QG _ �9_�/ - /�� -�ha � ��: ,�� _ . _ ---- - - ,-�-.��� , . - _,��. ,,,,.... �y�',: : �- ,�`,�'-"`,{;a- zti';'�.�_;;, �� •�PROP.ERTY,OWNED!BY�CI:AIMANT IN�:�OTHER`COUNTIES [F'..',is_','.�.�,.'� ,-� : . 4.�+��.��,'4�`a=�'� "c5, ,°.s'+�4 County Tavnship County Twvnship I hereby certify Ihe above statements are true, cortect and complete. �atur lai nt �` � � aress (num6u ar�d sheef, ciry, stafe, ZIP code) • '�����' � �r�"`r � � "N"���" ""' � � = TRUETAX�� ASSESSED�YALUE �HOMESTEAD' '�tNON-RESIDENTIAL � x.. ' �SESSOR-���ONL��^�'.�y7_� ,+R_�'�VALUE�'�'y� "ATx100%.OF�TTV# �=`VALUE�'"'� ��-'s-�?' �VALUE���"� ��H'�i',�. aa. `u"v nrr:-k.�..n�,.�.ss.,_• ,e,� Land nol exceeding 1(one) acre immediately � ���'' yti�'� y ess,'�*��3 .� saZ��"� surrounding residential improvemenls. ( � �:t�'�` . ,fr������r��s �; Other land ` � " � �z� �a=�+ , =��� Tdal land (line f plus line 2) (g� ��3`'`?% ` s��.'�`�'�'�z��'. Dwelling (4) ka F c X•y'"" Residendal improvements or Mnualry ����`'��"�'`�''4""'#� � °�r:,? .:° y.-='c Pssessed MoWla / Manufactured Home Garage (5) "`��4�. . - 5:r: ; � -�� '�` '.�w' �_ %=4'i�'� �,'S -- Other improvemenis (6) -� �����,���� ,_.i: , Tdal improvements (line 4 through line 6) (�) Tdal value (line 3 phs line � (g� I hereby certify ihe above is We, corted, and Signamre otnssessor Date signed complele. Verifying aclion - SignaWre ofAUditor Date signed 20 _ Pay 20 _' I lesser of 1l2 Homestead g vauanon w E35.000 signed