Homestead_Dupps (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM
' CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R5110-01)
Pntsoibed by the Department of Local Govemirent Finance
INSTRUCTIONS., See reverse We for filing instructions.
YEAR
t D
(We) i� certify that onAhe 1 st day of March, 20
1 (We) occupied as our principal place of residence the folio 'n described real property for which a Homestead Prope�rtyy T�ax� C�redi�as he�rsby dai /med:
❑ I (We) owned ❑ Are buying under contract 019` SON rf�t i�Y
UOITO°
'Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
etl�4CONTRACT
RECORDED
".-
It buying on contract, Fee Simple awnees name �-
Recordees office where contract is recorded Record number Page
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1e"ASSES�.SOR�U�SE,ONsY. - °�'
Iii ROPERf DESCRIPTION
Count
Twmship
Taring district (city, town, township)
/Pq� /�)eI
mbar (
�3 `' O�
Legal 8WAP60
Is the property in question:
❑ Real property ❑ Mobile Here (LC. 8.1.14)
H any ponbn o/ the residentlal &in ch-re or the Ian rat exceeding one (1) acre Net immediately surourids that structure is used to produce income, describe the use and portion
of the property ublaed to produce income.
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1e"ASSES�.SOR�U�SE,ONsY. - °�'
County Township -
County Township
hereby certify the above statements are true, correct and complete.
Si tore n
W
�i 1171 —;w'
1e"ASSES�.SOR�U�SE,ONsY. - °�'
-- TRUEcTAX*`
VALUE'
ASSESSED VALUE
'FAT100 %OFTTVV/LLUE
HOMESTEAD_ y
NONRESIDENTIAL .
_.{FSVALUE%
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
` ;
L ia�1I
Other land
(2)
- - -
Tdal land (6ne 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Wig
_ £F{ aite
Garage
(5)
-�„_
i ,-s
2v
Other improvements
(6)
er.
Total improvements (line 4 through line 6)
(T)
Trial value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessw
Date signed
Veiying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1/2 Homestead
Valuation or $6,000
Date