Homestead_WorkmanCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fam 5473 (RB / 403)
Prescribed by the DeDartment ol Local Govemment Finance
INSTRUCTIONS: See reverse side for filing inshuctions.
FORM
HC10
YEAR
I(We) �� I i ��..��rti at on the 1st day of March, 20
I(W�pied as our principal place of residence ihe fol 'ng d cribed real property for which a Homestead Property Tac Credit is here6y daimed:
I(We) owned ❑ Are buying under contract
� Ha,ve a benefidal interest in the entity Nat is liable for fhe property taxes on the property and ihat owns the property or is {�ryiqg.�n deLa con�ar�,
/ � il s � i
r�,�-�.a�'�r��J%t3r''�`��� ��.�iP.t-`.z��'w�.�+ "`,•a��a-s�.si'.�''«.,°dCONTRACTRECORDEDi:..r,�d"�—a "'Ft sFn,-���}'X+t ��,w�t.:y��t`-t.:�F�:�.dt'_•�.:c-=
If buyMg on conUad, Fee Simple awnefs name
�t�' ? 2 2003
Recordefs ofice where conVad is remrEed Recortl num0er P
Cauny
Tamship
Z�`1 "c.)�i��i)-o O �- �--- �� a�
�N� � po�lon o/ the resiOenUal sWCWre w the IanA not azceetling one (1) aca Ihet
proPelty ut0ized tn produce itrcama.
County
1 hereby ceniy the above statements are We, corred and complete.
�Addreu (number aM sbeef, ciry, dafe, ZIP code) ,
Land not exceeding 1(one) acre immediatery
sunounding residential improvements.
Ofher land
TUaI land (I/ne f plus line �
Dwelling
Residentiel Improvemante or Mnualty
� � � �� H� Garege
ONer improvements
T�al improvements (line 4 through line 6)
Tctal value (line 3 plis line �
I hereby certify Ihe above is we, coned, and
complete.
Vaitying aclion - SignaWre oflwaiWr
20_Pay20_
Lesser of 1/2 Homestead
veuanonp f35.000
Signa4ue of AuCitw
(�)
1z)
(3)
(4)
(5)
(6)
I�)
(8)
Signature o( Assessor
S
�;:6SON
I Is the property in question:
Real property ❑ MoWle Homo (I.C. &1.1-� .
wrrounds that swGUre is used b produce income, describe Ihe une anE poNOn
ol daimant
Date signed
Date signeC
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