Homestead_BurgerCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse sido for lifing instructions,
I (We) CI—EA AaA.4 jL- that on the 1 st draF'8 vach, REL
I (We) occupied as our principal place of residence the following described real property for which a mestead Property Tax Credit is hereby claimed:
❑ l(We)owned ❑ Are buying under contract
NL1 Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or Ls,—yi�ng �un Va,
buying . , . contract.,
WEC iWV1W., �-�Ar'i.�--r-�CONTRACT=RECORDED�' ;f-I
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
tp---� �t?r ROPERT.Ye
�WKW mmop -DESCRIP
County
Township
Taring district (city. town. township)
Pa
66S—
Legi
4n 1
Is the property in question
-,—) 4 430 -0�
CiL)
[:1 Real property ❑ Mobile Home (I.C. 61.14)
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 the property utilized to produce income.
�7
�Waras
WAR W�W-'Ozwz"Mwam' TANDARD.DEDUCTION'ALLOWANCE���t��-X't',�Z�r4�
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Vazure of claimant
Ad e w (number and street, city, state, ZIP code)
S31 IN q166r
Signature of Auditc,
-.TRUE-TAX �---',:
-ASSESSED YALUE
rHOM'E6TEA6
NOA1991fiRN L0
WWI
AT�1100%'OF'
W
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
a . ebl�&4
R
Total land (line I plus line 2)
(3)
Dwelling
(4)
'4W M-1-43
�'X � 1
w-.' �:'IfI
Residential Improvements or Annually
Assessed Mobile I Manufactired Home
Garage
(5)
Other improvements
(6)
Total improvements (Me 4 through line 6)
(7)
Total 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
�Waras
WAR W�W-'Ozwz"Mwam' TANDARD.DEDUCTION'ALLOWANCE���t��-X't',�Z�r4�
20 _ Pay 20
Lesser of 112 Homestead
Valuation or 535.000
S
Signature of Auditc,
at l*ed
T? -7 ------