Homestead_YorkR t CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
�/ State Form 5473 (RB / 4-03j
Prescribed by lhe DeOarUneni o( local Govemmen� Finance
INSTRUCTIONS: See reverse side Ior filing insinictions.
� FORM
HC10
YEAR
� M�e) L.. certi(y t�t on�e 1�t day ofMerchy 20 }3
I(We) occupied as our principal place of resid e followin escribed e property for which a Homestead Property �mc Credit is�herebpaele(m°ed
❑ I(We) owned ❑ Are buying under coniract SEP 0 a 2003
`Have a benefidal interest in ihe entity that is liable for the property taxes on the property and that owns the pjoperty or is buying under a contraU.
If bytig an conVad. Fee Simple owners name
Rewrders ofice where contract is recorded
Counry
Toxnship
Legal
Record numEer � Page
Tating district (ciry, tawn, rownship)
Is the property in question:
f� ❑ Real property ❑ Mobile Homo (I.C. 67.1-7)
If any portion ot Me residential sW cWre or the land not exceeding ona (1 � acre tAat immediatey wnounds that swcWre is used to produce inmme, describe Ne use and pwtion
ol the prapeAy uEtized to produce income.
j��� s'�,A ESS�OR' SE� ONLY � ���� i TRUET�r �� ASSESSED VALUE �HOINESTEAD 1*'�` N N RES�DENTIAL °t�`.{�'
,.p'�p. : y _. -�. _���.�,:x� y x.r� �VALUE��'� : AT.�700%O � V� � VAI!UE� �����VALUE��-�:;?��
Land not exceeding 1(one) aae immediatety F. "a"` �"� `'^'�°' �
�. ..�,.. c �'t;-�;
sunounding residentlal improvements. (� � ������ ��-
- 3• :,�� ,e��y.e .
Other�and `+ ��-�"?c'�
(,I) �_" .;.-,;.2u•
�v:.'�..'f-r-z�_z .-:
Total land (line 7 plus line 2) (g�
� +�. � 7 7 +'-�- �{ii�_ ..�- ^[
? h � � ��
Dwelling �Q� ���� �4�i�d "'�
Residentiel improvements or MnuaOy �"�"E`""'��'�"�""`�' � � -
Assessed Modk I Menufaetu�ed Home Gara e , �"�' .5.-
9 (5) ���',�°���.�.i• �`�
�� " �''� s�
Other improvements (6) � �,,,,,�> �,��,
TUaI improvemenLs (line 4 through line 6) ��)
Tcial value (line 3 phs line n (g)
I hereby GeAify �he above IS We, corred, and SignaWre of Assessor Data signed
complete.
Veritying actbn - Sgnatura oflvAimr Date sgned
- -�CY �.t'' :�kp..vxir �- �' l.i'�"�'"£' v-rx 'u -r"-. : " -$5#y,x`��
'�w�+t..t.> -:_ �� ��i.� - -.3�.a,7'�" .;STANQARD;�EDUCTION'ALCOWANCE.-i�r,�P'- x�fk...>a�:'' � '-�'`e^'.•e" �€�`-rf�S`.�s.c�,e5r_:.�
20 _ Pay 20 _
Lesser of 1Y2 Homestead
vauauon a f35.000
5
Synahire of Auddw ' Date n �
-03