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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Slaie Fortn 5473 (R6 / 1-03)
PrescriEed by the Departmenl ot Local Gavemment Finance
INSTRUCTIONS: See revcrse side Ior /iling inslrucfions.
� FORM �""! 'r^�YEAR
� �� HC10 � —{ �
tl � i ;J
DEC 1 2003
� �e) :y� certiry-)h � thev�sl�day'o'f Maicli� �2(1n �
I(We) occupi d as our principal place oi residence Ihe following described real property (or which a Homestead Property T�e Credit is hereby daimed:
❑ I(VJe) owned ❑ Ne buying under cont2ct
Have a benefidal interest in ihe enGly that is liable for the property taxes on the property and fhat owns the property or is buying under a conUact.
Counry
Tamship
Legal OescripUon
Is the
tawn, townshiP)
Real Droperty ❑ Mobile Homo (I.C. bf.1-�
H any portion of Ne residential sW cfure w Me land not eaceeding me (7 ) acre Nat immediatcy wrrounds Nat st`ucwre is used tn praduce income, desfii OO ��a��
of 1he property utiaed to produce ifrcoma.
D yz� -vb a
a lo-�a -o � -
`'�'� �`"'°•�- ���µ �'���ze-� ��'TRUETAX�,�' �ASSESSED�VALUE �HOMESTEA��` ;j NONj'�RESIDENTIAL�'��"�
.�s . ��..._ �� � " � v �
.�a� -� ASSESSDR�IJSE ON}Y�, '�io"` X YALUE+� � "�ATt100°/a.OFTN �,�VALUEK �' + 7t �` VALUE:�' v' � ��
� „�.n<. :'�°9b4* _at$�`5:..�$i'?..,....a. '�"..�'u �_- ...c � � .-�.�...�..�-� .c.>, ....r�� G����rin°'�.�-... ...,is.9=.�r�
Land not exceeding 1(one) aue immedialety ��t" p�.,�'J-^"�''-ry.t.��`� ��Y?i
surroundingresidentialimprovements. (�) �����.�.z�°��i;:
Other land a` �`�". �=y� :i` �
(Z) -`'`��`?.,�
r..x.r. ueSE+r_�._.
TUaI land (line 1 plus line 2) (g)
�� ��Xn��3wS3YST�. �. � .�
Dwelling (4) ��a y 3 r,� �
Residentiel Improvements or Mnuatly �,g ','�',,
0.sxessed MobOa / Manufac�red Hame Garage (5� f5 r��c.���"��' ��,�'i,�r�'
��.''i`.�,`v"m "�'r ,...t:::?x?
.�?;`- ..��;���i
Other improvements (6) �M �',,'s;GGi;Kxv�
3� z:iz;`f_1m �
Tolal improvements (line 4 through line 6) (7�
TUaI value (line 3 phs line n (g�
I hereby certify �he above is W e, coned, and Signature of Assessor Data signed
comptela.
Veri(ying aUion - Sigiuture oflwAiwr Date signed
°1 . Ft'i' _..�..-n.z. .. : . .. I +';�'g" rc�s z *.:_.. i.'vrass ' • - 4 , '.u"N,^ `�'_ ""
^'��?��",-�-�a,.z� '"-�;�,��`�STANDARD:OEDUCTION'ALLOWANCE,.�;�,k i.��;,,;�s�,s,y-z.�':'1��_�t�"��.-,�.�.,,:;<
20 _ Pay 20
Lesser o112 Homestead
wuanon or f35.000
S
Synature of /wditw " Date s'gned