HomeMy WebLinkAboutHomestead_Griesemer�_ ; CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
/ S�a�e Fwm 5473 (R6 / 1-03)
Prescribed Dy the Department of Local Govemment Finance
INSTRUCTIONS: See Bvcrsc side lo�lilinq inslruclions.
`�� FORM YEAR
HC10 �
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�F �� ��r iU
�(we> �` � �
_��,4,'� n l 0.n n ia�-, n� l certity ihat on the 1st day of Maich, �20
I(4ye) occupied as our principal place oi residence Ihe following descnbed real property for which a Homestead Prop�,rty�Ta�Gedit�is-lieretiy daimed:
WJ I(VJe) owned ❑ Are buying under wntract ��• G�5S��� ^� "� (' v��L' �^
� Have a benefidal interest in the enfity Uiat is liable for ihe property taxes on ihe property and that mms the property or is buying under a conUaG.
II buying on conVad, Fee Simpie ownefs name
Remrdefs oifice where conVaIX is
Counry
Parcel
Tamship
descripGon
�/1 1 (O — (.JCJIJ I CJ I \ ��i{,a_
If any portion of iha residential sWctura w the land nd axceeding one (7)
ol lhe properry ulilae0 tn praduce i�ome. �
.°°. 3
/ S
Tating
Rewrd number � Page
Uie Oroperty in quesUon:
❑ Real prapeM ❑ Mobile Homo (/.C. 61.1-n
�ds �hat sWCture it used lo produce income, descri6e the use and poNOn
�. 4 :�.�-�� .�_� - - - - - � .
. .. » . _. .., _ � __.-_ _ � .aa tin= _
-.m: �. :5�..a„�.�;�--„r�.� '�°�:�',�-`s' PROP.ERTY;OWNED�:BY�CLAIMANTIN!OTHER'COUNTIES�.,,��s'.�'n+,.���"=�_',!'�3i4f�q.�'i�.'�
County Toxnship County Tavnship
I hereby certify the above sfatements are We, wrred and complete. Signa e of claima n
Mdress (number eM street ciry, sfata, ZIP cnde) �
�.y. -• l, n.f... =� - . i " i - .T • .�s +r L ' -R
:�'�:�;�_�;�.r�����'%���',���svwunao;oeoucnoN�auowniJCe��, ��•�;,�,��:;��a,-c`s3���.����T'�a�;,�:�
20 _ Pay 20 _
Lesser of 1I2 Homestead -
vauauon w E35.000
5
Synature of Auditw " Date sgned