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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
t Stete Fam 5173 (R6 / b-03) ^
' PresaiDed by the Oepartrnent ot Local Gwemment Fnance �' �
INSTRUCTIONS: See iaverse side fw!ling insfnrcfions. `��
FORM YEAR
HC10
R•
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L"i }.. .:::�:�.t .'!.�'i..^,51� -.�h.v..••-•• ^il .5..�..:.l�\�LRIIrIl�N11UlY�.JINICMCIVI : ..... "-"=•:� ' �- �;�•
� M�a) certiry Nat on Ne tst dey oLMarch, 20_
I(We) ocwpied es our principel place of resitlence Ne fdlowing d cribed real property tor which a Homestead Property T� Credit is hereby daimetl:
�] I(VJe) rnvned ❑ Pre buying undar cont2C
, Have a benefidal interesi in ihe entiry Nat is liabla (or ihe pmPerty [�es on Na proDerty and that owns Ne proDerty or Is 6uying under a conVact.
m canvea, Fee S�mpa ownxs neme
rs a�fice wnere ca,vaa is recordea
Tamstdv
Pa�l� \—a�1�5"�i I'
lJ
If any portim ol tha residential SWChiro w I�e
d Ne proparty unLzed W pvduce inmme.
)t exceeding a (1)
Id� %I�
�
Cauniy To.vnship County
�_ I hereby certliy the ebove stetemenLa ere Wa, cortecl and complete. Signatui
''tlmss (numDer end straof, ciry, staro, Z/P cotle)
� _ _.
fown.
num7er
Pape
❑ Moeoe F1ome (�.c 61.1-n
w Ncoma, Cesaibe Ne uu en0 poNm
� �i
20 _ Pay 20 _
Lesser of 1R Homestead
Vatua9on w 535,000