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� � CLAIM FOR HOMESTEAD PROPERTY TAX
� � CREDIT/STANDARD DEDUCTION
` � State Farm 5473 (RS / 10-01)
�b� Prescribed by lhe Departmen� of Local Govemment Finance
INSTRUCTIONS: See 2verse side lor (ling inslrucfions.
FORM YEAR
HC70 � O �3..
� M�e) �, ��:..C� certify Ihat on the�lsf day di'M5FN4�20_
I(We) occupied as our principal place residence the following described real property for which a Homestead Pr rty Tac Credit is bereby daimed:
❑ I(VJe) owned ❑ Are buying under contract �;�R J /
�iave a benefidal interest in the entity ihat is liable (or ihe property taxes on the property and tha[ owns the propertqe�Syt�ii'' 'dekd�tVqya�
If huying om m�Vaa, Fee Simple owners name
Recorders oRice where coMrad is recorded
��a��G�l"t�F� "'�s�A". .r�_ _.M''�.''--�'..� 5�3.k� '��..'���
County Toxnship
�`I� —�� �O6'00 �� ��'n� �c�
If any poM1ion of ihe resiAentlal sWcWre a Ne land not exceeding one
of ihe proPeM util¢ed to produce i�oma.
Tating tlisVict (dry, town, lowruhip)
Is Ne property in
Retord number � Page
,�a�m ❑ �bile Homo (/.C. 6f.7-�
acre �hat immediately surtauntls Ihat sWGUre is use0 b praduce income, desaiba the use and portion
,�� ��'� ��"���`��x�� �" "�' ��s�"TRUETAX'� e �ASSESSED�VALUE =HOMESTEAD�`'a'' �� ��A
'�?-��- �ASSESSOR USE ONLY�� � ,�y�UE��� ALil00%OF'TTV �'�' � VALUE� E �?`s VALUENTI�AL •5
� ,.�z�:�t..i i7a^=-�z`fa3{:*.k"'�._ �a�°.?is ... i7�.�.._r . x.�; , �-.a....� �Kifi:�;5.,-,. ....,� �i��.rt..,-i, � ..-l�a...,'��
Land not exceeding 1(one) aae immediatety �����"�"�� .;"� . s'-'��#s�s �^.
surrounding residential improvements. (� � .°_, �'��, .� �y`iF���,�.��;
�.����� _
Other land '�+`-�' �" +�� �
(z) fs�Yi�; ae
�-Pq.�i'a �....�u
T�al land (line 7 plus line 2) (g)
:A r•yi` IM 1+� j3.µS•-C� � i;
Dwellin9 (4) 9. �-�'ac{'�'�" - �';
Residential impmvements ��ar� .'€E . 3 {
-•-=-a--
Garage (5� � �a ` '.� {'� -f'-. ���
� �
'a�
Otherimprovements (6) _.�'� �.�is�
;-,��ra'
Taal improvements (line 4 through Irne 6) (7)
TUaI value (line 3 phs line n (g�
I hereby certify Ne above is We, correcl, and Signature otASSessor Date signed
complele.
Verifying aaion - Signature oflwditor Date signed