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44 rt�* � CLAIM FOR HOMESTEAD PROPERTY TAX
= CREDIT/STANDARD DEDUCTION
S �, State Form 5473 (RS / 10-01)
����� Prescribed by lhe DepaAment oF Local Govemment Finance
� INSTRUCTIONS: See reverse side /or filing insWC(ions.
�� �;�fl. � ". � �- . - , • . . . �- CERTIFICATION
���
FORM YEAR�
HC10
�(We) � �,�((„Y�� _0 certify lhat oCn C[hIe� 1 st d?ay n(Mn�] rch, 20
I(VJe) occupi as our principal place of residence Ihe f' wing described I property tor which a Homestead Prope07�i�c Cre�it �Vkfeby daimed:
❑ I(We) owned ❑ Are buying under contracl
�Have a benefidal interesl in �he entity thal is liable for Ihe property taxes on the property and that owns th r ert^ ^^ ��
"`�r-t�-"= a�.�';a .. :a.��;.. . _ _ ._.—= .. ... . .. .'-.CONTRACT'RECORDEO �_:_' . . - ' _ .., . .'. �� .. .
I( buying om m�traa, Fee Simple owners name
Remrdefs office where contract is recorde0
Counry
_�f.
Tawnship
IJ�V "1JL) 1 J�'Z.VR_ J'd'�(,
�.idential swctura w the Wnd not eaceeding one (1) aae that
to produce income.
Record number
r
Page
ESCRIPTION � � .r.. �: .. $ . :;..,.: � °; �i 1:,' 4�..l��:.
Tadng Oistrict (ciry, fowq fownship)
� Is the property in question:
❑ Real DroDerty ❑ Mobile Momo Q.C. 6f. f-7)
iai y surrounds Nat sWUUre is used to D��uce income, describe ihe use and portion
t�s=-t����T �' ' � �� �3 '� - '; � ; � TRUE-TAX � ASSESSED VALUE �HOMESTEAD �' �p f NON RESIDENTIAL 4"' ��-� �
��, E,� �'� � AS$ESSOR USE ONLY _._ r �..r =. �-. VALUE:. .. -�: AT 100%OF.ITN' . , .-� VALUES , `. ��' ;,- ' VALUE '..��+-'t``�^"
.??1+1r:?.c'� �,T ..Jf., r ti . �1� .. .1.-i n .1 ..t--4'.' t si �
Land not exceeding 1 (one) acre immediatety �� �+ � � � �`k_ � ��i �-0 : _
surroundin residentlal im rovements. � f�' �` � �
9 P ( � �,°F.".-::,,.,g�...r�'"w =,=��:...
l y � r!
Otherland (p) $ - �,;,ti .�
-,,,
Total land (line 1 plus line 2) (3�
t i a , --
y-� � � + __�i _'
Residential im rovements �elling (4) `�� a� �, y3`�� �`_� � .F� '
P ::i� 4�*h� „r * =.,.kF���
Garage �5) . p av � ;�s�"� ��� a�>:
�
-n. �!_-.'- i,_; '
Other improvements (6) - _
Tdal improvemenfs (line 4 through line 6) (7)
Tctal value (line 3 pl's line n (g�
I hereby certi(y the above is W e, correG, and Signawre ofnssessor Date signed
complele.
Verifying aclion - Signature oflwditor Dale signetl