HomeMy WebLinkAboutHomestead_Douglas (4)�.,� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
S�ale Form 5473 (RB / 1-03)
PrescriDed by the Department o1 Local Govemment Finance
INSTRUCTIONS: See Bverse side /oi (iling insVUC(ions.
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I(We) (� � (/ I W V �� — ce�fy lhat oi
I(We) occupied as ur principal place sidence the following descnbed real pmperty for which a Homestead ProDe�
❑ I(We) owned ❑!ve b under coNract �
, Have a benefidal interest in ihe enfity tliat is liable for th
c'��.�.}`v'�x`��.�... ��'`"`:�'��'. �'` e �"�',"'�'?,� , M �
If buy'ug om m�Vaq, fee Simple owners name ��
Remrdef5 olfice where conUad is recorded ^ .
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v
County
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r�sniP
L a d�utl�(dn� ` ��
If any poRion of N8 residentlal sWGure w Ne land nol axceeding i
of the properry uWized to produce income.
o�� - ���5a-e
Counry
Tavnship
I hereby cerUty �he above sfatements are We, corred and complete.
dress(n�u�7pe/r�eiMsfree(ciy,s/faJ(� ZlPcode)
i.� L/E 3 /"-]�� /�1 V� r. � e
FORM
HC10
YEAR
7sl day� (,Mprch, 20_
Credit e �ereby daimed:
Page
�'y Q���^ � J Mobile HOmo (I.C. 6f.1-�
��"'1 ., 0 Iincome, tlesuibe Ue use antl portlon
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Coun�y
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