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CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
� Slaie Fwm 5473 (R6 /40:i)
Presaibed by Ihe Department ot Local Govemment Finance
INSTRUCTIONS: See revcrse side !or Iiling insWc(ions.
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_ HC70
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_ YEAR
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I(We) _� )���1 l/ /� � � cerh� ihat on the 'Ist day of March, 201
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I(We upied as our pnn ipal place of residence the following described real pmperty for which a Homestead.Properly�T�c'Credit ishereby�daimed:
lily.�.U,. , , e�i�,_^_
I(We) owned ❑ Are buying under contract '
� Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns Ihe property or is buying under a contraU.
If buying on conVacl, Fee Simple ownefs name
Recordefs afica where conVacl is recoMeA
County
Parcel numher
Tavnship
Legal description
Record number � Page
(ciry, town,
the property in question:
Real D�opeM U Mobile Homo (I.C. 61.
If any portion ol the residentlal sWCture w Ne land not axceeding one (1) acre t�at immediatety surrounds that sWCWre is usetl lo produce income, descnbe the use antl portbn
oF the properry ulilized b produce income.
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F��:.�'�e_ -:�f��.F'e.�"�,.�.-'��.�PROP.ERTY,OWNED;BY�CL'AIMANT-IN;OTHER"COUNTIES�.�;'�'^:2���i'r�`p�-��-�'S."1�.?."_�
County Toxnship County Tavnship
I hereby certify ihe above statements are We, conect and complete. Signawre laima
�reu (num6er and sheef, ciry; sfate, ZIP cade) � �
S�".sTw'��',-�����''��'`�i����`�.���,'3'�r;'�"���"STANDARD;DEDUCTION'ALLOWANCE�.�,s'�''���is`�'.,. xz...,,�>i��`?�',a�.��'��r'-`u'-c�'.
20 _ Pay 20
Lesser of 1/2 Homestead
vaivaLOn or S35.W0
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Sgnamre of Audriw � Date signed