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' CLAIM�FOR HOMESTEAD P.ROPERTY TAX
° CREDIT/STANDARD DEDUCTION
t Stata Fwm 5473 (R6I4-03)
' Presaibed by Na DepartmeM af Local Govemment Finance
INSTRUCTIONSi See iaverse side for filing instn�ctions.
FORM
HC10
YEAR
��B) certify N�l�'tln theA s W��arch. 20_
1(We) oaupied as our 'n 'pal pla of residence the fdlowing described real property for ich a Homestead Pro�p-eyrt�y T�c Credit is hereby daimed:
�I(We) owned Me buying under convact p�t� ,Q�
Have a benefidal interest in the entiry ihat is liable for Ne property texes on the property and that owns th��g��p�jp�yiyW��pRonVect.
Counry
If any pwtlon o
o( Na property
Tovnship
Legal
town,
ihe property in Quastion:
❑ Real property ❑ Moble Home
uaential swcwre a Me Iand not exceading one (1) aae /t imm� ery� � Nat swcture is used to produce income, descnba Ne use and portion
b Droduca incoma. I I
5 �
a�, - � � ,.
:.��::+.^.,.. ,,,,ta...:'f!'�„s:'�t��y�„'��,�e�P,ROP,ERT`/�OWNED�BY_�CLAIMANT;IN.OTHERCOUNTIES:rr�*,,,,r__�:�.�F^. .a.�..�.: s�.�..a�,.`.-�:. �.�;, �'�
Counry Twvnship County 7o.vnship
I hereby certify the above ststemenfs are We, correct and complete. Signature of Geimant
mss (number aM sUeat dry, atate, ZIP oode)
� ���+'�`�-"�*�ASSESSOR-.US�EjONLY�,`�y�g-�3� �„�TRUE�TAXr��Y ASSESSED VALUE HOMESTEAD : ��� FNON',RESIDENTIAL�N� � "�
�"a�'�+>u +�-i.-�^.'��.. _?.__.3�'u��[�...ia'c�t5.°.z�i'`�}VALUE�'Y+..±., �AT;100%OFdTT�V ,c._.xVALUE.�"�'l��t.-.x?,>1z'�,VALUE�y�,`iza ���
Land not exceeding 1(one) acre immediatey . -4���'� ,�� �x,�'��� ii��.:�
surroundin residentialim rovements. ��� sS x=� '�'
9 P �x �„�, �` � �;}z��, 3s,
. ' 3..�"_� °.N¢':-Y-i
Other land �y) -'""' `r -� -
„�;
Ta[al iand (line f plus line 2) (g�
(yl s' I't �'li 'T .aJ u �
Residential improvements or Mnually �'elling (4) ;: � st� �_ i ;� s��_
Assessed MoWle I Manufaclured Homa .' �,�};+�-*^{ -=
Gara9e � (5) �:� i � - ' c � "�� �
�.:-� ' :.-t
xy e
Ojhel improvemenLS (6) -.i6�'
*�'...' _ _
7dal improvemen4s (line 4 through lirre 6) (7� _
Tdal value (line 3 phs line n (g�
I hereby certity the above is We, correct, and - Signaare otASSessor � Date Wgned
complete. �
Verifying action - Signawre of PLditor Date siBned