HomeMy WebLinkAboutHomestead_PeeteCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (Re 1403)
Prescribed try the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side for filing instructions.
I Ir
PER F
i-z P FIC�AMTION STATEMFW
I (We) o" TM of March, 20
I (We) occupied as out principal place of resi ce the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that �GIBS4WA I, "Xnr --contract.
NTRACTj'RECORDE
If buying co contreq. Fee Simple owners name
Recorders office where contract is recorded Record number Page
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=01
NSTNUEMiR 019N-1
County Township
County
Tomiship
Si nalure of claim p"
Taxing district (city to" toww
00053
Legal descri
&!4lype q::,4,on
IrR Perry Mobile Rom 1.
If any portion of the residential structure or the land not exceeding one (1 a
of the property utilhed to produce income.
a that imnrxxliataU� oudds that structure is used to produce income, describe the use and portion
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=01
NSTNUEMiR 019N-1
County Township
County Toxnship
I hereby certify the above statements are true, correct and complete.
Si nalure of claim p"
Address (number Vas ZIP code)
d... , = 'zk , d
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=01
NSTNUEMiR 019N-1
'NONRESME-jf'AM,
VALLI
—E
Land not exceeding I (one) acre immediately
surrounding residential improvements.
T. ;l
Other land
(2)
Ell,
TO
T# ry
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residents] Improvements or Annually
A Mobile I Manufactured Home
Garage
(5)
.= T-ITE Z W,
5
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(S)
I hereby certify the above is true, correct. and
Signature of Assessor
Date signed
complete.
I
Ventying action - Signature of&ditor
Date signed