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a.�'-" , CLAIM FOR HOMESTEAD PROPERTY TAX
� ` CREDIT/STANDARD DEDUCTION
l�, � z State Form Sa73 (R2 / 5-92)
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INSTRUCTIONS: See reverse side for liling instiuctions.
FORM
HC10
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YEAR
��We) _ � - certify thai on t 7st day of March, 19
�'e) occ ie ur pnn al placebf resi ence ihe following described real property for which a Homestead Propert i�s�ret� � laimed:
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L� I(We) owned ❑ nre buyiny unde� cono-act , . AUDITOR
❑ Have a beneficial inieres� in the entiry ihat is liable for the property taxes on Ihe pmperty and that owns Ihe property or is buying under a contract.
, CONTRACTRECORDED � �
It buying on contmcL Pee Simple owners name _ .- .
Recorder's oHice where crontract is recorded Record number Page
PROPERTY DESCRIPTION
Counry . Towny.nq _ (� Taxing tlistrici (cey, rown, fownsAip) .
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Parcel numb/er t' /�, legal description �� �/J� I/1 o /��
� �i \.D�L301 �lJ / ��. //n —a— �� o !S c�� lf.lC
If any portion ot the resWential stmcture or Ihe land noi ezceetlirg one (1 � aae ihat immediatety surrounds that stnxture is usetl to produce income, describe
of the pmperty utilized to produce income.
use and portion
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTtAL
VALUE VALUE VALUE VALUE -
Land not exceeding 1(one) acre immediately
surrounding residential improvements. - (�)
Otherland (p) I
Total land (line 1 plus line 2� ��3)
Dwelling (4)
Residential improvements
Garage (5�
Other improvements_ (6)
Total improvements (line a through line � �7)
7otal value (line 3 pbs line 7) (g) �
I hereby certify the above is Ime. correct, and Signamre of Asseswr Date signed
complete.
"tying action - Signature of Autliror Date siqned
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ALLOWANCE
19_Pay19_ -
Lesser ot ll2 Homesiead
Valuation or 52.000 �