HomeMy WebLinkAboutHomestead_Denbo4,� R�n � CLAIM FOR HOMESTEAD PROPERTY TAX
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` > SUte Fwm 5473 (RS / 10-01)
���� Prescribed by the Department d �ocal Govemment Finance (((���
INSTRUCTIONS: See reverse side Jor /ilinryjnstruccions� / �„� D
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FORM �
HC10
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I(We) �-'�� L certify thaTon4hehst�lyy�of ar . 20_
I(We) occupied as our principal place residence lhe following described real property (or which a Homesiead PE�a�ty� O r?dOO� hereby Gaimed:
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❑ I(We) owned ❑ Are buyi g under wntracl �
�Have a benefidal interest in the eniity that is liable for the pmperty taxes on the property and Ihat ow�he propertypr is�[iu'ying under a contract.
If byvg on conlact. Fee Simple owneh name
Rerofdefs office whera contraa is recordM
,: Tawnship
P V'V D O / 7 9-�egal Ae:
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i( any portion of lhe residential sW clure or Ihe land not
of the properry utilized to produce inwme.
�C�-/a_
T�cing
one (1) arfe Ihat immeCiately
County I To.vnship
I hereby certify the above statements are true, correct and complete.
L".9rew (/ uni berbnd sf•rel. ciN state. ZlPCOdeI /'i
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County
Record number Page
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pro In queslion:
� Real pmperty ❑ h7obilo Homo (I.Q 67.1-7)
�s . re is used lo produce income, describe the use antl poNon
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FR'Cfl11NTIFC=•s�....'=:q:..�i373:ii+`}'9rk�.,._'-°_T> "rat?�:.:
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� � L�"k � �:-�' "'" �� ` ` ` � - i �'�'4 :': TRUE-TAX ,- -' ASSESSED.'VALUE :�HOMESTEAD' � � NON-RESIDENTIAL"' � -�
����,��A�SESSOR�USEONLY � y+� .,y�VE�u .w. �AT100/a�OF:.TN-� VALUE;s�� r��� ���. VALUE`'r�^���.�"
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Land not exceeding 1 (one) acre immediately ( , �'� r�' �'�� � '�;� � � ` :'
surrounding residential improvemenis. � ' `_ s xf^t� ;,�.� �; � � k '
�- � .y
Other land (p) .;� � `� "•
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Total land (line 1 plus line 2) �3)
c-_ ia � �,f+� ..:
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Dv+011ing (4) r� i 1�4 h�-;?`z x�P.Y-.v'"`YS�,��.i
Residential improvemenLs t - .li � ..
et .�� ..ys--
Garage (5) ;�� t'��`�����vr=•��- .">=
y n}y[.�? k � ' �.�ih{
fS:,
Otherimprovemenis (6) V`� �µ�,� � �-ra;^;'
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Total improvements (line 4 thmugh Irne 6) (7�
TUaI value (line 3 phs line n (g)
I hereby certi(y lhe above is We, cortect, and 5ignamre of Assessor Da�e signed
complete.
Veriying actbn - Signature of Auditor Date signed
20_Pay20_
Lesser of 7!2 Homestead
Val4afion or $6,000
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