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:� t CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION `�
�'� � , State Fwm 5473 (RS / 10-01)
��° Prescribed by the Department of Local Govemment Finance \
\\i
INSTRUCTIONS: See reverse side /or filing instructions.
FORM
HC10
YEAR ,
� ��
1(VJe) 1�/ (� �Y �� L (-� �� �� N o 2m/+ certify that on the 1st day of March, 20_
I(VJe) occupied as our principal place o( residence the following described real property for which a Homestead Property T�c Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under contract
� Have a beneficial interest in the entiry that is liable for the property taxes on Ihe property and lhat owns Ihe property or is buying urder a contract.
� ��t�.�`rY��� � � �:=�-'� :-`t:�'= �3cz'�i: AaZf� i �:CONTRACT'.RECORDED �.,5=° { ic="y r'-<.- : F ..� ., ` � . .
.., >. . . . � ..> ,.,...� :
If buy'vig on conlract, Fee Simple owners name
Remrders ofice where wmract is recorded Record number Page
County
Tavnship
T�ing dis�nc� (ciry, fown, township)
Parcel num r Legal descnption Is the pmperty in question:
Q�� O�rp �� ❑ Real pro0erry ❑ Mobile Homo (1.Q 61J-7)
If any poAion of ihe residential sWClure w �he land not ezceeding one (1 � ane that immediately surrounds thai strucNre is used to produce income, descrihe �he use and portion
of the pmperty utilizeE to produca income.
. ._ __"' _ ' ' _ _' _ ' .
��a_ �"�'��s_f n��€._�-?� _-�!'='s�°.Mi.PROP,ERTY;OWNED�-BYCLAIMANT�IN��.OTHER�'COUNTIES ,.`�.����::°e'73+'i,�_'_:;�'c:ce,u '�Y�:':-�`F,:;=
CouNy Township County Tavnship
I hereby certify the above statements are lrue, correct and complete. Signamre of claimant
Address (number and street, city, sfale, ZIP code)
�z���'`��`�_�'�"'- `� "�--"��'-'���t�!�"b--"`t �-�TRUETAX � ASSESSEDVALUE HOMESTEAD`x�. '�' ✓ NON-RESIDENTIAL�`��:�
�- ASSESSOR USE ONLY �� 3�
�` ��=s�'�'''.�w�3::a<Yy.Y.,�_'�'���` _. �.€.-t^.�a+y�._`.:_ rVALUE� ' � :AT.100%OFTN.. _x-�;VALUEt�< ..��'� a .VALUE - °�'-�ry'
Land not ezceeding i(one) acre immediately �3i � S�F "'�,� ;' �.r;- ;-� � s. _-
surroundingresidentialimprovementa ��) '�� ��,.n;�� ,:-u����-
F� .a�' �3° z _
Otherland (2) - ^�%�`-"� ��,:
a..,:.`.�:'�'..
„�,.. �r,3�:�:
Total land (line 1 plus line 2) (3)
s.+ry. s;�xf i.t'� aY�v 's
Dwelling (4) ��� � ��5,������ y� qY
Residential improvemenis
Gara e �;��z .� ��`-�.r x�,'�- `-,.�.,c,�
9 �5) f `� � .�'1-'-�--�,� �� �Q a'�.`..
��+'°,n?sti�'3... �..e•1_ir <<�
.°, 3 ,�. l:_
Other improvements (6) 4' � � � :�cr.�� ,`�,}�
z �v`:.=?3 i._...;,�;,.�_
Tdal improvemenls (line 4 fhrough line 6) (7�
TUaI value (line 3 plus line � (g)
1 hereby ceAify the above is W e, correct, and Signawre of Assessor Date signed
complete.
Verifying aclion - SignaWre of fwditor Date signed
- . _ y. ,. - ...
�z-`�'.r�:.m> -.'�,..��,-.."��;r��.:,'`..3's`.�i"���:=STANDARO:DEDUCTIONALLOWANCE t'"vti_-i`�,{��.�aw`�=: -�.,�._'=�..�x�..i�--��..'=
20_Pay20_
Lesserof il2 Homestead
Valua6on or 56,000 S
SignaWre oflwdeor Date signetl