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Y 4 CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
� f State Portn 5473 (RS / 70-01)
���� Presaibed by the DeOariment of Local Govemment Finance
INSTRUCTIONS: See reverse side for filing insUUCtions.
� (we) /�/(a(A/I.C.L/! �/�Sc�r�I�..tA.sz� t��
I(We) occupied as our principal place of residence the following described real property
❑ I(VJe) owned ❑ Are buying under contract
�`iave a benefidal interest in the entlty that is liable for the property taxes on th�qE
I( buying an conuact. Fee Simple ownefs name
Recordefs olfice where contracl is recorded •
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Caunry Tamship
County
of Ne residentlal sWCUre N the land not axcaeding one
y utilaed to produce income.
Tavnship
County
a
(tiry, town, township)
FORM Y AR
HC10 � � �
lhat on the 1 st day of March, 20_
'ropefty Tac Credit is hereby daimed:
or is buying under a wnUact.
Rewrd number
Page
�he property in question:
❑ Real Draperty ❑ Alobile Homo (l.G. 6f.7-7)
ids that swcture is used b produce income, desaibe Ihe use antl portion
I hereby certify the above statements are We, corred and complete. I Si�na�ure o( claimant
Tpvnship