Homestead_WolfCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stete Fum 5473 (R614-03)
Presaibed by the Departrnent of Lxal Govemment Finance
See ieverse side fw filing insbuctioru.
� . �
FORM � YEAR
HC10
� � � � �
I(We) W � /L �� certify that on the tst day of March, 20
I(VJe) occupied as our principai piace o( residence ihe follow described real property fo. which a Homestead Pro➢ert�Ta���d'( is hereby daimed:
// (G N �/.
❑ 1(We) owned ❑ Are buying under wntract Q V
C��BSON COUNTY AUDITOR
, Have a benefidal interest in ihe enfity that is liable for the property taxes on lhe property and that owns e property or is buying under a wnVact.
I( buying on conVaa. Fee Simple owners name
Rewrdefs afice where contraIX is
Tavnship
�-0Q�l�JlO "lJll IL89al
T�cing dislrict (city,
I( any portion of Ne resitlentlal sW c4ire a the Wntl nW exceeding one (1) aae that immeCialety surtounds that
ot the property utilaeE to produce irkome.
County
Twrnship
I hereby certify Ihe above statemenLs are We, correct and complete.
and s6eet, city,
Record num6er � Page
❑ Mobile Homo (I.G. 61JJ)
is usetl to produce income, desuibe the use antl portion
20_Pay20_
Lesser of 1/2 Homestead
vaivation a E35.000