Homestead_Michel (7)i`'�•� CLAIM FOR HOMESTEAD PROPERTY TAX
� �!� CREDITISTANDARD DEDUCTION
Sta�e Form Sa73 (R2 / 5�92)
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INSTRUCTIONS: See rever5e 5ide lor liling in5tructions.
` FORM
�
HC10
YEAR
�) ti/�_�V V N V 1� V• \ �AA1 (�� 1 ��.7�> _ cenify ihat on the t si day of March. 19_
�upied as our principal place of residence �he following descnbed real property tor which a Homestead Property Ta i re i
,J I(We) owned ❑ Are buying under contract ���� �
❑ Have a beneLCiai interest in the entity thai is liable for the properry taxes on the property and that owns the property or is buyingynder a contract.
CONTRACT RECORDED
u twying on convacL Fee Slmple owner's name AU DITOR
Rewrder's off�ce where contract is recortled Rxord number Page
Coumy
Township
PROPERTV
Iown.
� � ry;yq?r Legal description �
. � -C67 � R-0 ,
II any ponion of the residential stmcmre or tne lantl not exceetling one (l) acre ihat immetl�ately surrountls ihat stmcture is used m produce income. describe the use and ponion
of ihe propeny u;ilized ro protluce income.
-/9-�/-/a/-�� '/re! 6�s
PROPERTY OWNED BY CLAIMANT IN OTMER COUNTIES
Counry
aby cenify the above statements are true. correct and complete.
�ss (number and 5lreet. ciry. stale. ZIP co�d..eA) /�
ii- � QiSI/. � / %� !✓+. //� A /1 n.. n �1 ,
ASSESSOR USE ONIY
Land not e*ceeding �(one) acre immediatety
surrounding residential impmvemenis.
Other land
Total land (line i plus line Z�
I Dwelling
Residential improvements
Garage
Other impmvements
Total improvements (line 4 fhiough lina �
Total value (line 3 p�s line �
I hereby cenify the above is tme. Correct. and
19_Pay19_
Lesser oi tl2 Homestead
Valuation or 52.000
TRUETAX I ASSESSED
VALUE VALUE
(ll
121
(3)
(4)
(5)
(6)
(�)
(81
Signawre of Assessor
STANDARD DEDUCTION
�
HOMESTEAD I NON-RESIDENTIAL
VALUE VALUE
Date signetl
Date Signed
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