HomeMy WebLinkAboutHomestead_KeenanCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
t Sfata Fortn 5673 (R6I4-03)
PrescAbed 6y Me Department of Local Govemment Finance
FORM �(��— YE—AR _fI
HC10 I , I
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INSTRUCTIONS: See /everse side fi� filing insfructions.
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,� �'_....�:,V�._ � .�,,�, .,�CERTIFICATIONSTAiEMENT:� t,�.�,� . - - �:f�� T �
� �e) ` � � . .. � � . . � .. ertify that on lheqlM,da�o(jvl �n '�20_
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I(We) occupied as our princip lace of residence the following described real property for which a Homestead Property Tac Credi s�ere�i� aimed:
I(VJe) owned ❑ Are buying under contract
Have a benefidal interest in lhe enfity that is liable for the property taxes on the property and that owns the
I( byvg rn conVaq, Fee Simple ownefs name
Recordefs ofice where contraa is recordeA
Counry
Tuvnship
Ta<ing
Record number � Page
el number Legal�qescrip6on Is ihe pmperty in question:
al-Og-10'{' ODI, J-3� a'6 ❑ RealpropeM O�ai HomoVC 6f f-7)
y poNon of Ne resbential sWCWre w Ne land not axceeding one (1) aae that immetliatety wrrounds that sWGUre is used b produce income, describe Ne use antl poNon
e property utilizeA b produce income.
20 _ Pay 20 _ I
Lesserof 1r1 Homestead S
V31ua40n Of $3$.p(10