HomeMy WebLinkAboutHomestead_Smith (60)� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
' / Slate Fortn 5473 (R6 / 4-03)
PrescnOed by lhe Departmenl ot Local Govemment Finance
INSTRUCTIONS: See reverse side !or /iling insliuclions.
FORM
HC10
YEAR
I(We) �����certi(y that o�'�e '�st� oLMarc�hr, —20,
I(W u' as our principal place oi residenc Ihe following described re property for which a Homestead Prope �Cr it is hereby tlalme �.�,
j( �+ Efi g ►1
I(We) owned ❑ Are buying under wntract �./ � J 1`S
' Have a benefidal interest in the entity ihat is liable for ihe property taxes on the property and ihat owns the property or is �i�l�g under a��� ^aU.
I( byvg on conVap, Fee Simpla ov:ners name
Counry
County
where conirad is recoMed
Toxnship
- c�asorv cour:7 • q�o�T�
Rewrd number Page
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�hip)
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\ 1 / T �O, Real ro
` J� �� I S� i— � v �• l/ Gc C. C De�1Y ❑ Mobile liomo (/.C. 6/. 7-7)
ol Na resitlentlai atrucNre ar Ne land not scceeding one (1) ave Nat immediatety wrtounds that sW cWra is used to protluca income, Cescnbe the use and portion
y utilized b produce i�ome.
I hereby certify the above statemenls are W e, corted and complete.
Land not exceeding 1(one) aue immediatey
surrounding residentlal improvements.
Other land
TUaI land (Ilne 1 plus line 2)
Dwelling
Residential fmprovements wMnualy
Assessed Modle / Manu(actured Home Garage
Other improvemenls
Rlal improvements (line 4 through line 6)
Tdal value (line 3 plrs line n
I hereby certify the above is We, correU, and
complete.
(�1
1z)
(3)
(4)
(5)
(6)
I�)
(81
Signature ofAssessor
signed
Date signed
�'r�r,�a.x��� :�'Y'�^7r"`�''''t' �.��',-s';STAtJDAR�:DEDUCTION'ALCOWANCEt „"�""`-z- -*;;?r �� �, ����
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.' 20 _ Pay 20 _
Lesser of 1l2 Homestead
v&uaum a 535.000
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SignaWreoflwCitor " Datesignetl