Homestead_EstepCLAIM FOR HOMESTEAD PROPERTY TAX
'� CREDIT/STANDARD DEDUCTION
t � Sfata Form 5473 (R5 / 10-01)
�� Prescribed by Iha Deparimerrt of Local Govemment Finance
INSTRUCTIONS: See reverse side !oi filing insfructions.
FORM
HC10
YEAR
i(we) (.cr' / Il CS/ �+' C'S�. c�GN th�.o�heNs�otll�arEfi, 20_
I(We) occupied as our ' cipal place ot residence ihe following descrtbed real pmperty for ich a Homestead Pro T� t" hereby daimed:
❑ I(We) owned Are buyirg under contract N�l V� �b `�b��1.
�Have a benefidal interest in the entity ihat is liable far ihe property taxes on the properry and ihal own� property or�is b}i�ng unde,r, a cgntrad.
If buyumg on wnVact, Fea Simple ownets name
Remrders ofite wheta conVaq is retaded
Tonnship
Record numDer . � Page
r� i numoer �ega1� p}Q� �� �� _�� I I Is Ne proper/y�n question: � .
(1, C.. �ij j Real Drapa ❑ MoMle Homo (I.C. & f. f-� .
H any portion o/ the residenUal sW cNre a th lend nd exceedinp one (1 J aca thet immediatery wrtounds Ihat cNre is used to produce (ncwne, deuribe ihe una end portbn
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Tawnship
Counry
Tawnship
I I hereby certify the above statements are We, correcl and complete. I Sig ature ot GaV trn�a.n`t� � �
c�1
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� �=:�-�`.-L��.���i''�2" . .�.�-'�STANUARti:bEDUCTION�nuowa+ce��:���:-�;���,-�` �,- s �.�i2�����
20 _ Pay 20 _
Lesser of 12 Homestead $
V�uadon or 56,000
Signanue olPutlitw ' Date signetl