Homestead_Schantz� '' CLAIM�FOR.HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
t State Fortn Sd73 (R614-03)
' Prescribed by the Departrnent af Local Caovemment Flnance
� INSTRUCTIONSr See reverse side /or filing instn�c6ons.
FORM
HC10
YEAR
e,,•-.;�d �..re. ::. �.-n,6,..±i�.�:� -� ' - ^ x:- ..'� ?,.,GCKIItIGA00N.57ATEMENTd��.. '� - . i�_.•_: -
I(We) certify Nat on the tsi day ot March, 20
I(VJe) occupied our prindpal place of residence the following described I property for which a Homestead Property Tmc Credit is hereby daimed:
i^] I(We) own ❑ Fve buying under contract
' Have a benefidal interest in the enUry Nat is liable for Ne properry taxes on Ne property and that owns Ne property or is buying under a conVaa.
It buyln8 on co�treq, Fee SimWe ovmefs name
Recordefs ofice where conVaq
Counry
Township
Parcel number I
� -� ao�� -
If eny poNon of Ne resiOential shucWra w Me
d the property utllizad to ptoduce Income.
a�-���3-�
Record numbar
distriG (ciry, town,
Pege
Is Ne property in queSUon:
3-' I' � pmDerty ❑ Mobile Home Q.Q 67.1-�
I acre � at immqdlatey surtounds Nat strucWre is used ro produce income, dascnba Ne use and portion
W
'S" `!x � .`�'x" '''�"� g� �-`�i �T' e �VE�7p,X{.�.s`�� ASSESSEDVALUE �'HOMESTEAD- �:.�''`NON-RESIDENTIAL `
�r�� �ASSESSOR USE ONLY X, � ��� ' ,4 �. f - ,
ti�. <�k#��.�.ti�t't!*>.�..:c, r*&-.'�-`_ a?i!tr�:?.�'`�VALUE� „ AT;100°/.OFT7N w 'VALUE< '�i, ��,i�s�l;kv�k�VALUE�.,:c.'""'-�'_:i�.
Land not exceedin.g 1(one) acre immediatety � �:, r�^� rt� .y„�,ca .�£ F,':
surtounding residential improvemenis. � � '�.>.. ,. ; �,�yy,-: ,- ,, ,;r;�,��.,�;
-r
Other land �Z� - - - "" -
�i'i�v
T[tal IarM (line 1 plus line 2) �g�
�33 ?7� '� -:
Residential improvements or Mnualty �����9 �4) r ',; , v � ,y �" - �,,.
Assessed Mobile I Manu(actured Home „+-. u � x� 5.��
Garage �g� :' -
•�...�> >�4.'�'•..�+r
O�her improvements (6) - �'��`����•'• =
`..= -
Tatal improvements (fine 4 through lirre 6) (7�
Tdal value (line 3 plis line � �g�
I hereby certify the above is We, cortect, and � Signature ofnssessor � Dam sipnad
complete. �
Verily'u�p ecNon - Slgnature ofAuditw Date sipned
20_Pay20_
Lesser of 1/2 Hanestead
Valualion w 335,000
3
.i`�. ,.ai •�r,,:l� 'e.'s.-<-
.
Dat� n-d� � � / !
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