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` CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
t State Fwm 5473 (R6 / 4-03)
' Prosaibed by the Department of Local Govemment Finance
� INSTRUCTIONS: See reverse side lor �fing instniclions.
I (We) I
I(VJe) pied es our prindpal place o( residence the following described real property
FORM YEAR
HC10
.l$qn:d{Cvi'l.:�d .':l'.��:�? [:.?:..
ihat �n-�e t d of Mamh, 20_
�p�� is heraby Gaimed:
1 I(We) owned ❑ Ne buying under contraci y ���� �
, Have a benefidal intarest in the entiry that is liable (or Ne property teues on Ne property and ihat o MAdia ro e s buying under a conVact.
�� bu)Mp on conireG, Fee 54nple owners name
Recordera ofice whera conVea is recorded
fown, township)
Racord number � PaBe
����0/�Dw �,'� I�� I�_�-II '�^ /�_ �IsNeDropeO Realproperty ❑ MobOeHOme(IC b71-�
L� l�'{•� I Y�'�-;
II any porUon of Na res�den6al sW Gure or tha land not azceeding ona (1) aae that immadiately surtounds ihat strucNre Is use0 to produca Inwma, dascribe tha use and poM1ion
d Ne p(operty uWlzed W produce inwme.
�?w�i�SL.,xivd+':Mt1t�1�'d�'sfrS--,-,='3v���+��_�`;<iP,ROPERTY:OWNEDiBY�CI:lUMANT�iM�OTHER'COUNTIES� �:-y.:.}-., .��,,,-.� . '�:=::. ..
County Tonnship County � Toanship
I hereby cerUfy the above sietements are W e, wrtect and complete. Signature ot Ueimant
(number and stree4 �+ry, atafe, ZIP code)
���, SSESS RU'EONLYtt-�s`��'�`+� ��'�UE �'rr�.�+�"'� ASSESSEDVALUE -HOMESTEAD��;';'"� °NON�RE3IDENTIAL � _
�'
M. ���',.,:..,...r�rr.r,��,rr. »:�.'F4.N' ��..�;' ,.-_..�. ---,� x r,�..VALUE �� "� AT5100XOF�T.Na :_:.�VALUE �� �..� ;; r e,i.,�-+VALUE ". .
' ..�r, '
Land not excaeding 1 (one) ave immediatery �� � •;;,t£ � - -- ; ?
surtounding residentlal Improvamants. _:��n � ,:,:. _y. , . ,. �. _ -
Other land (2j �� - ;; _
.^z:. , . -:-...�.�.
Tdal IerM (l/ne 1 plus line 2) �g)
,
Dwelling (a) :i`x' , :. � d , � . -
ResldentlellmpmvamentsorMnually ;iH,,.;>.y,;,,.-;3,,;g;::a_,.'.:;;-,..: -._
Pssessed Moblle I Manufacturad Home •� �, T �-- � ��:
Garage �5� . ...::�t ` ;'-
. - i Y � ' ?: � r'
• i:� ' ,.��:�:t:.:.'(.:. �:...:.-_ , ,'_
. rr�.,...,a.. .
ti
O�pet Improvements ' (6) '
Tdal Improvements (line 4 fhrough line 6) ��)
Tatal value (line 3 phs line � �g�
I heraby certi(y the abova is we, correcC and signawre otnssessar oata sipned
complete.
Vaiying adion - Signe¢ire of Puditor Date signe0
( .;'� ..�.?,i",�J�iF+'����;u.`,=a'"`r.,-�c:i,:?c a '-1•;,.�STANDARD!DEDUCTION'ACLOWANCE..� :,:a... -- -
' � 20 _ Pay 20 _ �
Lesser of 12 Homestead
Valuation or 535,000 S
SlpnaNreofPUditor � �( ^ � � Datesigne� /O^�
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