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' CLAIM FOR HOMESTEAD PROPERTY TAX
° CREDITISTANDARD DEDUCTION
t I Stata Form 5173 (R6/d-03)
' Presc+ibe0 by Ne Departmenl of Local Govemment Finance
INSTRUCTIONS: See rarerse side fa �Jirg instructions.
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FORM YEAR
HC10
lv
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r:s <a .. �.�.'i �r-.'z�.::•w� a� _ � � �.r,'•c:tNilFiGAT10N5TA7EMENT..:•'dsr� - . i. .a a.-h 1 .... �� �:Gp.<t-'..
��a) ceNry that on tha 1st day of Merch, 20_
I(N/e) ocwpled es our prindpal pla e resitlence the foliovring dascribed real property lor whfU e Homestead Proparry Tec Credit is hareby deimed:
� I(We) owned ❑ Me buying under conUaC
. Have a beneficial interest in ffie anGry that is liable (or ihe properry taues on Ne pmperty and ihat owns Ne pmperty or is buying under a conVSCi.
It buylnp on contretl, Fee Simde wmafc neme
RecarCeh of5ce whero mnVad is remrdeE
Recok num0er
Caunry 7ownship Tming ELttrid ( . own. towri$nip) .
Paecel number Legal dascnD�� Is tha pro rty in quastlon:
� - eel pmperiy
I! e�ry portion ot Na residenHal struaure or the Iand rid e¢eea'vg ma (7 � acre at rtmma7iatey wrrwrws Wt swctura Is use0 to podw
of Ne property uN�ed W produce inmme.
. . � rj �t- � � � (z.�
rwosnip
I heraby cer�fy Ne above statamenls ere we, corteci end complete.
"'tlress (numDer end sLeet, ciry, state, ZIP cada)
Sgnetun
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❑ MaWla Home (I.C. 6�7.1-�
a Inwmq Eaaibe Na use anE porticn
{��..,,ry�`�TASSE SOR'USE�ONLY� �'�,s�,i y> i��i-�yp�UE �,,,.' i pATiE OX OF TiV�� �.''H�VALUE�D{� f' NON VALUE�ALxt1 Si %
..�.,.a.c... �.a'.�..7v+.. ..xi!r+}�ht.�d .2s�. _ �:i�. �'i%:' i5"-r, _Se°ai,riJ?tsk�1
_ ,. . . .. ..... .. _ ,. .. . .<_
Lend nat exceeding 1(one) ecre immeaiatery {r� c.;,y �.� �-ti� �� f
surtounding residentlal improvements. (� 4`_+'.S{ k'�y"`��� 4:
� Aar=:�..�-�.i:i'-<...;;';,.is : :. }_a:.a
ONer land �Z� .- �° �'
.:, w
* r i�; _:
TCai land (IMe 1 plus line 2) �g�
Dweliing (4) s kr �� � m.' �F,� „`�
ResldentielimprovementsorMnualty '' wi� n+ai<`�"�-'�"-��
Assessed Mobile / Manufactured Hwne e . � �-��.�, ix��� �} � �, - � .
Garage �5� � -n . � .y s ;
--�a:- :�T:,��"..T-S.i^ ..,.,iil;�:,.;i.,5i'ia
.._._:__ _ .....: ...
�,.:
Ojper improvemen6 (6)
Tael Improvements (line � throtgh I(rre 6) ��)
Tqal value (line 3 phs line � �g�
I hareby Certify Ihe ebova is WB, CorteCt, end SlgneNre olASSessor Date signetl
complete.
Vailying eaion - Signamre ot Puddw Date sipneE
20_Pay20_
lesser of 72 Hwnestead
Valuelion w 535,000