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„� CLAIM FOR HOMESTEAD PROPERTY TAX �
CREDIT/STANDARD DEDUCTION +�
State Form 5473 (R6 /t-03) ' n ��
Prescribed by the Departmeni of Local Govemment Finance ��
J
FORM YEAR
HC10 �
INSTRUCTIONS: See reverse side !or Iiling inslnicfions �
��yc�`�M � � '� �Y"' � + + ^ ���CERTiFICATION-STATEMENT�r�tr'� s ..� .T`f'
. _ ,�, _���.�--��.�� �_ - -- .. _ _- _�:�'�?`�'�:xU,:.��`?.���;��:'4?e`�,
I(VJe) certify thal on the 1st day of March, 20
�I(W ) occupied as our principal place of residence fhe Ilowing descnbed real property for which a Homestead Property Tac Credit is hereby daimed:
(We) owned ❑ Are buying under wniract
' Have a benefidal interest in the entlty that is liable for the property taxes on the property and ihat owns the property or is buying under a conVaU.
If buy'vig om m�Vaa, Fee Simple ownefs name
Remrdefs oifice where contraq is recorded
Caunty
7amship
V I y� V/� ��� ��/� � u�-f�i� �.xQ.i�%
N any portion ot Ne residrntial sW cture w the WnE not exceeding ona (1) acre
of the proparry util¢ed to produce inwme.
Is the propert,—y ,in/�u estion:
lJdReal proq
Record number
❑ Mobile Homo
Page
67.1-7)
surtounds Nat sWGUre is used to produce income, descnbe Ihe use anE portbn
=-,�w ��+t-t�'Rrr- _ _ -t.�s �. -�,.,
��`ani"-...-``a��,s�„��.� .3?��.�`"��'P,ROP.ERTY;OVVNED'-BY�CL:AIMANT;IN.'OTHER`COUIJTIES��:r-� ,�i,t���y�,�t �t,�','�'r�*'�?y
County Toxnship County Twvnship
I hereby certi(y ihe above statemenls are We, corred and complele. Signature al claimant
Address (num6eraiMs7eet, city; sfate, Z/Pcode)
.4���v��iASSESSOR� � ONLY �^,y:� �� ���"�ALU �3�`�� ATxt OYe OFTTV 'HOVALUTE 'U.� f ` ���� VALUENTIAL�'�
� a�a�'�� �'�._-"`'?11,Ss..s�3'�"� -.�`-� �.. _� ...e'�S?'� _ �.�S.t ? .2*'-$?.'.,,.,. .,�� �s�rr•s;:;«...,a _� �'���
Land not exceeding 1(one) acre immediately � °�"°'*n> � 3 ���.y'�3:.'E�^
surrounding residentlal improvements. �� � 'y+ ��,1�t��, �i� ��+����'
.� r -t. _ l>s* < ..n:a.'-��.
'�w��-d"'�,� .
Other land �2) � ,,�cE �,
s
� -ss�"' "ii:5
Tdal land (Irne 7 plus line 2) (g)
� '3'ah-r .r�' �
Dwelling (4) -� ,.�. � " u �"��r%`qr �' i
ResidentielimprovementsorMnua�y x�- ^��+'�.`��'+��--�-#'°' ��
Assessed Moble / ManufaQUred Home Garage 5 r����.� ,€��`���
( ) �..--�� „-
;��s s..* i�'�''�. ` ''F";z. !
Otherim rovements �";"�`� �"�
P �6) q.*s'.a';�'
Talal improvemenis (line 4 through line 6) (��
Tdal value (line 3 plus line n (g�
I hereby certi(y Uie above is We, corred, and Signature otAssessor oate signed
complela.
Vaity'uig aclion - Signature oflwditor Date signed
�:�.'�fl.�^-�=i�� �a�,.�".-`��"xsi�4 �Sa��-'`r,,.`,'�Si���a-�-'-STANDARD'.OEDUCTIONAL[OWANCE�.;.,3'.�:?l�¢,a3?�.,"�a�.-a"'z'n5�t�7E,',�"sr.�'�.�.`°`'.'±�o?`�=±t
- 20 _ Pay 20 _
Lesser of 1/2 Homestead
vawanon or E35.000
5
SignaWreoffwditw " Datesignetl