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, CLAIM FOR HOMESTEAD PROPERTY TAX ��� FoRM' � �1 YEArt '
' CREDIT/STANDARD DEDUCTION HC1a � ;L �J �'-�'
State Fwm Sa73 (R6 / 4-03)
Prescribed by Ne Oepartment d local Govemment Finance c[� � J Z004
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INSTRUCTIONS: See reverse side (or /iliny inslniclions.
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,.s._:��. .:�,���'`�� "Y.�:i�'* ��, � CERTIF.ICAl10N-STAiEMENT�4#?_� 1��.?`"�. �'�(� "r`'•. :z.�. '-.i��-i��:`�i��`-�
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I(We) Fertify Ihat on the 1 sl Aay of March, 20_
I(VJe) occupi s our princip piace oi residence the following described real property (or which a Homestead Property Tac Credit is hereby daimed:
❑ I(We) owni� ❑ Are buying under contracl -
�Have a benefidal interest in the entity Nat is liable for the property taxes on Ihe property and ihat owns the property or is buying under a wnVaU.
If buying an conVad, Fee Simple ownefs name
Retordels office where canVad is recordeU
Counry I Tamship � Taung
Rewrd number � Page
Parcel number Legai de`sc,rip1tio-n, ^ Is the property' estion:
tX� b- o � a e q � 1� �CJ ��� d� � d� •_ � Real DroOeM ❑ Mobile Homo (/.C. 67.1-7)
If any portirn of Ihe residential sWcWra w ihe land not axceedin e!+i� � a that immediatety wrtounds Ihat sVUCWre is used to protluca income, tlesaihe Ne use antl portion
of Ne DroDe+N uhlized tn produce i�ome. •� J��t�.. �. ..
'-i= °`"v PI��.�.�`r°aqp�e�„``'s_-.`�`"�si�??�'.=: STANDAR�:DEDUCTION'ALLOWAMCE�=,'?��"�Z-"�� �z�1���.5�"�'�'��.'�-`..�s�..�"iF�`�,,, �� "?'�'+7� ,X�,''�!''.�.'
esr��'���i_._ - w a xa3'w:'F
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20_Pay20_
Lesser of 1/2 Homestead
vauauon w 535.OW 5
SgnaWre of P�ddor - Date signed