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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
/ State Form 5473 (R6 / 1-03)
Prescribed by t�e Department of Lacal Govemment Finance
INSTRUCTIONS: See revcrsc sidc !or /iling inslructions.
FORM YEAR
HC10
a -�� e
� ��;��
I(We) `� \ �� �certify that on the�lst day of Ma� c�h, 20
I(Wej o ied as our principal place of residence fo ing described real property (or which a Ho�ipe�stead P��rop�e�rty Tac�'-Cred� er�by daimed:
❑ I(We) owned ❑ Are buying under contract ��" �'` �n�-��
: `.f O �:,''�i�(T�� rl
' Have a benefidal interest in Ihe entity that is liable (or the property taxes on the pmperty and that owns the property or is buying under a contraU.
If buying on contrad, Fee Simpio awners name
Remrdefs office whera conVaq is remrEed
Counry
Parcel number
O'��Q�y
I( any porlion of NB resid
of the property uGlized to
Counly
� � i � xaz�uc_�xii si o
sWClure or the land not exceeding one (1) aae
ite income.
Tavnship
I hereby certify the above statements are W e, conect and compiete.
AEEreu (num6erand sfreet, ciry, s(ate, ZlPcade)
Taing
Uie
surtounds that
County
Signature of
Remrd number � Page
� woceM Ll hwo�ie riano P.c. 6+. �-n
is used W protluce income. describe the use antl ponion