HomeMy WebLinkAboutHomestead_WernzCLAIM FOR HOMESTEAD PROPERTY TAX
" CREDIT/STANDARD DEDUCTION
� �. � Stata Form 5473 (RS / 10-0i )
�� Presaibed by the Departmerit o( Local Govemment Finance
INSTRUCTIONS: See reverse side lor filing instrucfions.
FORM YEAR
HC70
�
1(We) V/// certi that on the 1 da� of March 20
�I(W ) occupied as our ''pal place of residence the folio ' cnbed real property for which a Homeste P opertyT red 1�'s here dai ed:
(We) owned Are buying under cont2ct QIp9oN u�i g!YAp
'Have a benefidal interest in Ne endry that is liable for the property taues on the properry and that oxms the property or is buying under a contrad.
If buycmg on contract, Fee Simple ownefs name
Remrdars ofice wliera contrad
Counry
Twmship
�� /l—lA1 � ((JC -�vl
H arry portion of tha resWentlel atrucWra or Ne
W �ha propaAy W7¢etl �n produce i`rcome.
Tavnship
one (1 J 2ae thet
I hereby certify the above statements are We, cortecl and complete.
(num6er and street, dry, afafe, ZIP code)
County
lah.
Is Ne
Record numDer � Pa9e
Real DroOeM ❑ Mobile Homo (I.C. &1.1-7) .
ve is usetl b protluce imm�e, desmbe the uae end porUwi
�?.�'�=���"�' ��""�s�'-'''-�STANDARD;'OEOUCTIONqLCOWANCEx'`',�`;�."''-`„�•�'�"'�-'`�r�'�.:,���,--�`�"-,,.'�`'n���
20_Pay20_
Lesser of if2 Homestead $
Valua6on or $6,000
SignawreofNWitu " DatesigneA