HomeMy WebLinkAboutHomestead_Douglas (7)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Slata Form 5173 (R6 / 4ai) �
ReaaibeE by the Departme�n d Lncel GowrnmeM Fina�e
�NSrnucnoNS: s� �sw�as s�a, b.�;�,..
FORM
HC10
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� YEAR
I(We) 1 ��/ certify lhat on the 1 st day of Merch, 20_
I(We) occupied as our principal place o sidence ihe following described real property tor which a Homestead PropeM>Tac Cregit�ereby daimed:
!'/a�.. ,CS
e) owned ❑ Are buying under wntracf
GIBSON Cp�N7.X
' Have a beneficial interest in ihe entity thal is liable (or the property taxes on the property and ihat owns Ihe property or is ur gAuii�Tg6onvact.
I( buy'ug om m�vaq, Fee Simple owrrefs name
Recoidefs offim where mnVaa is recwded
CounTy
_�yiy5-
Tamship
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Tating tlist�T�(cjp; fown. (o iP)
I 1' �
Is Ne property in que5tion:
Record number
Page
r.lobile Non,o (�.c. 6,. e-n
N any portion e/ Ne resiCenllal sW cture w the Wnd not e:ceeding one (1) ave ihat immediatey wrtounds Nat sWCture is used b produce inmme, describe the use antl portbn
of iha ploperty uGl¢ed tu produce income.
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20_Pay20
Lesser of 1/2 Homestead S
Vauauon a 535.000
Signature of NWria � Date signed