Homestead_Williams (29), CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
.� State Fortn 5473 (R6 /4-03j
Prescribed by the �epartment ol Loca1 Govemment Finance
INSTRUCTIONS: See �evcise side )or /iling insfmcfions.
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FORM YEAR
HC70_ _ � _, �^
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��e) � certiy that on th�sl day.oLMercti�20 ///�
/�-li v.--..41,. �_:�r�� N✓
I(We) occupied as our principal place o( residence the foll 'ng described real pmperty for which a Homestead Property T�c Credit is.hereby daimed:;,.
v'cJV.:���._ a
I(We) owned ❑ Are buying under contract � J y
�Have a benefidal interest in the entity Nat is liable for the property taxes on Ihe property and Nal owns the property or is buying under a wnVaU.
If huying on conVad, Fee Simple ownefs name
where mnVad is recorded
County
Parcel nu r
O / "� J�C
If any portion ol the resitl
ot the propeNy uWized b
Toxnship
fown,
Rewrd numEer � Pa9e
)_���� pti0n - / / /_ Ils�hepmperty�ueslion:
Y" • „ Real ro
/� dC/[.K V Oerty ❑ MoWla Homo (/.C. 61.7-7) .
strucWra w Ne lantl not exce�ding one la) e ttiat immetliatey wrtauntls that swGUre is used to vroduce income, descnbe the use antl portion
ice intome. 1'� r/ / ^ [�
�d 77
�seS'-"�-T-�' ���a�'.���i=��"sPROP.ERTY:OVIVNED`BY CLAIMANT;IN�OTFIER'COUNTIES>.��"n `'srx''"'.����'�3.'�'��'.v"�0��^,�i°�%i
County Tavnship Coumy — - Twvnship
I hereby certify the above statements are We, corred and complete. Si nature ot claimant� �
ress (numberaMs6eet, ciry, sfate, ZlPCOde)
"`�`'`.�.�''�"�-t'^^:rta� ��'i?K.`�`}-°„�'--3 `�t�-'--`STANDARD:DEDUCTION�'ALLOVNANCE��'`,'�,"'p;,'�..�a�,--�cm'�'�.t,'�'••�6�-'°�3�E'.+��5,_'���'_�.* xy`-�,—Y'
20 _ Pay 20 _
Lesser W t/2 Homesread
vauanon w 535.000
5
SgnaWreofAUddor " Datesigned
;9