Homestead_Wildt (5)�} CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fwm 5473 (RB / 4-03)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See revcrse side /or filing lnsWctions.
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ocT 2 � 2003
� M'e) certify U�t'6ri�the-ist day"-'o`f�Marcfi: �
�O �qc�1PLC rINT1'' -UUIT n i
�) ihe following described real property for which a Homestead Prop�rtyT�c C;re�i[ is hereby da�med:
I(We) owned ❑ Are buying under wntracl
, Have a benefidal interest in the entiry ihat is liable for the property taxes on the property and that owns the property or is buying under a wntract.
I( buying on tonLaq, Fee Simple ownets name
Rewrdefs afice where conhaa is recor0ed
S_� i� O uict (�ry, town.
Record number � Page
Parcel num0er ^ G Legal description ^ �., Is the propert�y in/qu estion:
DO l0' 0 rX 1�.)— Q7 I O l�X�a IJ Real D�operty ❑ MoCile Homo (I.C. 6f.7-�
If any ponion of Ne residential sWCWre or the Wnd not exceeding one (1) aae Nat immeEiatety surrounds that swcwre is usea lo produce income, describa Na use antl portion
ot the property utilizeA tu produce income.
�� `�°``�"��"�"�����' ������;�'l�'RU AX ��ASSESSED�VALrUE��HOMESTEAD+: `` NON=RESIOENTIAL�'�r1y�
ASSESSORWSE ONLY�- � � . -s, o ., l,� +.
� ._ �' � ..�.T'�t5".'�'"�".,.!`�._r3i:����o-""-5�� �ACUE�� AT�00%OF�"TN�y 3�Ta�VALU� ���.r' c�-,VALUE�-�d�a'�i��
Land not exceeding 1(one) acre immediatety y„??�+-�.�-t'�`'g��,.�=�"�.��##-y ��
sunounding residential improvemenis. ��) �''z�'�� �..�„�,�'y.•�
Other land -+`
{ �- �,-
(Z) �:�_��
:.�-�.�.{�
Total land (line 1 plus line 2) �3)
Y '"�`.i=Y`�Tat ''- � �#:}
Dwelling (4� �b ��1� .�_���{�
ResidentiallmprovementsorMnuaDy � � �
0.ssessed Modb / �IaiuAac9�red Hmre = `.��� ts>,
Garage (5� �,-� , � yr �"' �
erAi3'v�'`�ea�. � •..:rb..,S3�
; ��,A�g'���
Other improvements (6) _t �y.�j `4�� _
Tdai improvemenLs (line 4 through line 6) (7�
T[fal value (line 3 plus line � (g�
I hereby certify the above is We, corred, and Signamre o(nssessor �ate signea ,
complete.
Ve`ifyin9 acUOn - Signature of Puditor Date signea
��'��.�'-?M.,�..' � '%-� � , � ,;ST/WDARD:DEDUCTION'ALLOWANCE�e�<�°.,,_ „i' ' �
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' ' . ;�.`���-��` �� z�'�-�`s�"�::�"���`'�`'�""�"_'�
20Q� Pay 20 Q
Lesser of 1Y2 Homestead
veueuon a f35.000
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SgnaWreofAUd'Rw " DatesigneA