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�� � CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
'y �: 1 S1ate Form 5473 (RS / 70-01)
Prescribed by Ihe Departmenl of Local Govemmenl Finance
INSTRUCTIONS: See reverse side lor7iling insiructions.
�- i�` `� ' ' - ._ . . -'_' n i-: � ' � . . � CERTIFICAT
I(we) I �
I(We) occupie as our principal place of residence the o owing descnbed real {. •erty for which
❑ I(We) owned ❑ Are buying under contract
FORM
HC10
YEAR �
I
n�r v=- cuuc
certify that on the 1 st day of Mamh, 20_
i
stead ''dpe T�c Cre " is reby daimed:
� ���
' GIB,. � .-Y SUDITOR
� Have a bene5dal interest in the entiry ihal is liable for the property taxes on the iper� ' � own_ . is buying under a contract.
L — —
If huying on conVaa, fee Simple owners name
RecoNefs olfice where comracl is rewrded
n../ 1__l_
P rcel mher
Iranyponiono theresiae�
of the property uWized b p
.F; ti
�
— . :. ; ,., -. ,
'." CONTRACT'RECOR � ;;.;� c � � . ;; . .. ,._._,.+_. _ .i:-,
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_ Rewrd number Page
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:PROPERTYDESCRIPTION'�. �'�" `":y `"'.�` �"'i'•� .
T�cing tlislrict (ciry Ic ., township) � , ,
� �� � _
L ga descriptio Is lhe property in queslid I
� �` I I ❑ Real proP _Mc��
or the Wnd not eaceeding one (1) acre Ihat imme tety surrounds that swUUre is u�. �� .ce in am�
� SS � � /
: Homo p.G & 7. 7-7)
descrihe �he use antl portion
�'f�. a�'b.4=u -tt.�'.-s•, , --; 3._, ._._,_�. . .. . .. . __ „ `r. . . � r-��-.,
.,�7 =1, � r -.- TRUE-TAX � -� ASSESSED VALUE � ��HOMESTEAD NON RESfDENT1AL
�„x'+-,�,F�,K,`yAS.SES50 �S� NLY :� ..` �. yq�UE �. '.� � AT 100%OF�TTV � � VALUEt; . � �� s�i F -VALUE .,,'�� :
- < q r � -� x :'-.
Land not exceeding 1(one) acre immediately � u t��Z , �:�� �:
surrounding residential improvemenis. (�� �"''w' �" s�"�� f• ;� -.
x. - '
p* s ��
Other land � (2) -.:� ti"'.r.: �; `y �.
Total land (line 7 plus line 2) (3)
.�s �' 4 � s �`i � rT.s-S'�, �.t
Dwelling (4) �Pj,�, 2 �#H�';zx.:�:�?.;..x�'t-'�.->�v�.`_�'=€
Residentlal improvemenis . .
�y:�'" z�
Garage (5) ':���`3iw?�:+-,.a'�`���.�'�.t�% a'�
txti?�' � .� :
Olher improvements (6) �},. �
Tolal improvements (line 4 through line 6) (7)
Total value (line 3 phs line n (g�
I hereby certi(y Ihe above is true. cortect, and Signature of Assessor Daie signed
complete.
Vaifying aclion - SignaW re of Anaitor Date signed
20 _ Pay 20 _
Lesser of 12 Homestead
Valuation or $6,000
SgnaWreoffwditor �/ , `
1 �V.�.C%V VL%
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