Homestead_Haynes (9)�.
� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (RB /4-03)
Prescribed by l�e Depariment of Lacal Gavemmeni Finance
INSTRUCTIONS: See reverse side /or /iling lnslmctions.
FORM YEAR
�HC10 ' � �
�IS ti �.. �{ �1
� � �
I(We) � ceNfy lhat on the9sl�day,o�March{20�i
�S/.ts�/'�iNi. i.. •�i�/1'> �
I(VJe) occupied as our principal place of resi nce lhe following de "bed real pmperty for which a Homestead,P..ropertyLTae Gedit�.is hereby daimed
❑ I e owned ❑ Ne b /✓ U�V
(W ) uying under contract
� Have a benefidal interest in the enfiry that is liable for the property taxes on the property and that owns ihe property or is buying under a conVaU.
I( buying on conVact, Fee Sunple owners name
where wnVacl is remrded
County
Tomship
7ating aistrict (ciry, rown,
Record number � Page
�Y � 1�— �/C/� 1�`� I Legal d��tl 1• ���� V I Is the OroPe �"RealsGo�n:
p perty ❑ Mobile Homo (I.C. bL7-7)
If any portion of the residenlial sWC4ire or Me land nW exceeding one (1) aae Nat immediatey wrrounds that swcwre is used b produce income, desaibe the use and portion
ot ihe prapery uulaed b produce iMOme.
Tavnship
I hereby ertify the above statements are W e, wrred and complete.
4dd s(nvmber aiM s7eef, crty; stafe, ZIP code)
.� 0."1 /J. 1i0� S�7lDl� �!n.�ure�.nn i
Land not exceeding 1(one) aue immediately
surrounding residential improvements.
Other land
Tdal land (line 1 plus line 2)
Dwelling
Rasidential improvemenLS or Mnualry
� � � �� H� Garage
Other improvements
TUaI improvemenis (line 4 tltrough line 6)
TUaI value (line 3 phs line n
I hereby certiry the above is W e, oorrecl, and
camplete. .
Vaih�ng actbn - Signature oflwditor
(�1
(z)
(3)
(4)
(5)
(6)
(�)
I8)
SignaNre of Assessor
County
ign re of daimant
l '6 4• y�
� ie% �
Date syned
Date signetl