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E °. CLAIM FOR HOMESTEAD PROPERTY TAX
���� CREDITISTANDARD DEDUCTION
:�:;'� State Form Sa73 (R2 i 5-52)
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INSTRUCTIONS: See reverse side for liling ins(ructions.
FORM
HC10
YEAR
-V �\ f`1 W� �`�_J1JY��_U_�,(�L� _ certify that on ihe 7si day of March, 79
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I(1^!e) O upied as our principal place of residence ihe following described real property for which a Homestead Property Taz Credit is hereby claimed:
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% I(We) owned ❑ Are buying under contract �
❑ Have a beneficial interest in ihe entity thai is liable for the property taxes on ihe property and thai owns the pro�dQji'�'iyin�iq e�traci.
CONTRACTRECORDED -� -
II buying on comract, Pee Simple owner's name � � �
Recorders ottice where coniract is recorded w' r' ,�p � aq�
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County . Township
P�cel �u�'/e r � O Legal des
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tl any portion of the resitlential strucwre or the lantl not
ot the pmperty utilizetl to protluce income.
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PROPERTY DESCRIPTION
Ta<ing dstrict it`, lown, towhship)
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one (1) acre that immediately surmunds that structure is used to produce income, descnbe the use antl portion
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -�
Counry Townshio County Town i
i..<reby certify the above statemenis are true, correci and complete. Signan,re of claiman�
Adtlr (numberands7reeLaty.stal. �P e)
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
. VALUE VALUE VALUE VALUE -
Land noi exceeding 7(one) acre immediately
surrounding residential improvements. (�)
Oiherland (p)
Total land (line 7 p/us line � (3)
Dwelling (4) �
Residential improvements
Garage (5)
Other improvements (6)
Total impmvemenis (line 4 through line � (7)
Total value (line 3 p�s line � (g) �
I hereby certity [he above is Irue, corrett. and Signamre ot Assessor Date signed
� olete.
rg action - Signature of Autlitor Date signed
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52.000
Si9naWre of Audimr
STANDARD DEDUCTION ALIOWANCE
5