Homestead_Williams (7)a� -'"� g CLAIM FOR HOMESTEAD PROPERTY TAX
i,'�!' CREDIT/STANDARD DEDUCTION
�;��� State Porm 5473 (R2 / 5-92)
�e8
INSTRUCTIONS: See reverse side !or filing instructions.
. � - - � . -CERTIFICATION!
FORM
HC10
�
YEAR
I(We) �. 9�n �� . R. �.�z1d+ r. �. �Y CJ�`i��u�.��-�% certify that onethe 7�st dta of March; �i'�
�e) occupied as our principal place of� the tollowing described real pmperty.for which a Homestead Property ��di�erHE9��aimed:
ia�
(We) owned ❑ Are buying under contract n
❑ Have a beneficial in,erest in the entity thai is liable for the property taxes on the property and that owns the prope�o[i;�gyyir�Ond��qJract.
. �� . . CONTRACT RECORDED . � .
It buying on contrea, Fee Simple owner's name •
Fecorder's oHice where contraci is recortletl Record number Page
� - PROPERTY DESCRIP'fION
Counry Townsttip T�ing disvict (city, (owq (ownshrp) _ .' - -
�
Parcel num6er Legal descnption
-l�( �a�'f 2Sb .
If any portion of the residential simaure or the Wnd noi exceeding one �1) aue that immedia:ey sunountls that structure is used ro produce i�ome, describe Ne use and portion
ot the property utiGzed to produce income.
. . . . . .
-/d�//- 3aQ-oQ/. 3�9-��S
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County Township Counry Township
,�reby certify ihe above statemenis are irue, correci and compiete. Sgnacu of Gaimam •
Address num r an <treeC city, sfat code)
I � �- - �a,�..p� N Z
ASSESSOR USE ONLY . TAUE TAX �. ASSESSED � HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
land not exceeding 7(one) acre immediately
surrounding resideniial impmvemenis. (�) � '
Otherland (p)
Total land (line 7 plus line Zr (3) I
Dwelling (4) "
Residential improvements
Garage (g) �
Oiher improvements (6)
Total improvemenis (line 4 through lina � (7)
Totai value (line 3 pLs line � (8) I
1 hereby Certify �he above is Vue, correci, and Signature of Assessor Date signed
complete.
Veritying action - Sgnamre oi Auditor Date signed
�
STANDARD
19_Pay19_
Lesser of 1l2 Homesiead
Valuation or 52.000
�
Sgnamre oi Audi:or `� I �arc S�y-� ^/ -
1 ` 1 J.C�+-� \ d-lo