Homestead_ThompsonCLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R13 / 12-09)
y� Prescribed by the Department at Local Government Finance
�WUCTIONS: See reverse side for filing instructions.
FORM
HC10
]p TT Ti N R
IF. IC_ATION NT��y 'STATEME
-4
• s�" J// �/I /L II=
. .
:
place of residence or .� �•
claimed
er \ -n•. ..: is
cooperative m (are) entitled to occupy as a tenant-stockholder of a
Have a beneficial interest in the trust or the right to occupy
Am (are) the shareholder, partner or member of the entity that owns the property.
1 a`s�i:1�s ?x?...rtaJ.,.S.i'":.6.s irs CLSAIMANT Si INFO RMATION
r
license I Iderifification /
�. nts spouse . Other
/ / /
�Fr"6CONTRACTi RECORDED
i+??. ?, *,yr j°•..��A'as,.ck;'3'.rz i'r -i.� ::r�
Recorders offioe where contract is recorded
F. xC igFROPERTY'DESCRIP.TION.v.
"•'�ijys; *?;x, sS .7x.,,K PROPERT ,Y;OWNED�BY:CL /AIMAhT:'IN OTHERiCOUNTIEStj„646
■
i
�. r� f� ASSESSED VALUE:'t`L-s
HOMESTEAD -`� ',rNON: RESIDENTIALlrrj_- 1
>' y'x�ASSE9SOR U E ONLY
S{Xm t.. p.�TRUEJAAX.VALUEM I',AT_000!OF.TTV, F.,sr
.nVAL•UES +x��+ ,VAL! UE.«..K}:- -.r..%
Other Improvements
Total impmvements (line 4 through line 6)
cerft the above Is true, correct,
tify
and complete.
7enaby
"LOWANCE
_pay/iRDDEDUCTiON
.1'.. 7t
is
we-h �f2) of &a assessed value of the mobde home or MnLdachmd hone.