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Homestead_BedwellCLAIM FOR HOMESTEAD PROPERTY TAX CREDIT/STANDARD DEDUCTION State Form 5473 (F5 I I0.01) Prescribed by the Department of Local Government Finance INSTRUCTIONS: See reverse side for filing Instructions. FORM YEAR HC10 L - -D (we) ce on the 1,t day of March, 20 1 I (We) occupied as our inclipal piece of residence the following cibed real prpetyfar which aHoV �teadjProperjyjTaUr edit is, perel'claimed: OCCUP as 0" r7 p ❑ I (W1.) cw,..d ❑ A Are buying under Contract L R 'JRC�Ot4 Cot Have a beneficial interest in the entity that is liable for the property taxes on the property and that ownsqQ9.N COIJ,- 0 a .pertly or is buying under a contract. V �,J�'OfW 'i'-CO NT RACT-A ECO RDEW '!i!= i.ka If buying on contract, Fee Simple owner's name Recorders office where Contract is recorded Record number Page P -ERTYDES1CR[PT1 ROO, Coun Township Township Taxing district (city. toivtohip) Pa I in r Legal it Is the ropeny in Question: on: X Sig of Claimant n 7511 NE � —3 — 101 ljl,)o Ar NReal property El While Home (W. 6"1. 14) If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income• describe the use and portion of th ti dr �—e I . -'Nt—z V4 County Township 'HCI-MESTEAD�72' County Township I hereby certify the above statements are true, Correct and complete. S Sig of Claimant n W �(8num� ber R Lb IN 4 7( �—e I . -'Nt—z V4 _2�-rjRl.1E-,TAX0 -14 'HCI-MESTEAD�72' NON�ftESIDENTMV , W,� I W-1,11 0�t.VALU E V-- A -F4 Land not exceeding 1 (one) acre immediately S re of ditor Dale ?*j��_ surrounding residential improvements. Other land (2) Total land (line I plus line 2) (3) Dwelling (4) .—W Q :& Residential improvements Garage (5) Other improvements (6) A AN Total improvements (line 4 through line 6) (7) Tdal value (line 3 plus line 7) (8) I hereby certify the above is true, correct, and Signature of Assessor Date signed complete. Verifying action - Signature of Auditor Date signed TAIN16ARIDIZEDUCTIONALLOWANCIEf 20 _ Pay 20 Lesser of 1/2 Homestead Valuation or $6,000 S re of ditor Dale ?*j��_