Homestead_Gard�, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
SIa1e Fortn 5473 (RB / 4-p9)
Prescribed by the Oepartmeni of Local Govemment Finance
INSTRUCTIONS: See reverse side Ior filing instrucfions.
FORM
HC10
YEAR
��e) -��xm � � 1 �� �� certify that on the 1 st d oi�n�arch�tii�
I(We) occupied as our principal place of residence Ihe following described real property for which a Homestead Propert�"r�Crefiit7s I�epy daimed:
❑ I(We) owned ❑!ve buying under contract LU y
' Have a benefidal interest in fhe entiry that is liable for fhe property taxes on the property and �hat owns the �� rty or is bu�ing w��der a contrach
I( huying on coniraG. Fee SimO�e owners name
Remrdels ofice whwe conVaq is reoordeC
���s-�, fRJ€'.�.e�..+'-'ri'.�aYSnn���s�4'�`�...�
Cwinh Tawnship
Jr�r O 1�ll��-CJ I Legal dellPl l�
If any poNOn of Ne resitlential sW cture n Ne land nat exceetling ane
ol the properry utiized tn produce income.
County
I hereby ceAify ihe above statements are We, correct and complete.
4dd ss num ra�{ streef, city, sfafe, ZlPCOde)
, � /� � _ � %�✓ � ? q _ /�
Land not exceeding 1(one) acre immediatety
surrounding residen6al improvements.
Otherland
Tdal land (line 7 plus line 2)
Dwelling
Residentiel improvements w Mnuatly
Assessed Modle / ManufacWred Hane Garage
Other improvemenls
TUaI improvements (line 4 through line 6)
Rial value (line 3 plis Irne n
I hereby certify ihe above is We, corred, and
complete.
Veiitying action - Sigreture oflwdiWr
Nat
(�)
i2)
(3)
(4)
(5)
(6)
(�)
(8)
Sgnature of Asseswr
Record number
Tating disUict (ciry, town,
Page
I Is Ue property in question:
� ❑ Real property ❑ Mabi�a Homo (I.C. 6f.7-n
surtounds tha� sWCture is used lo produte inCOme, describa Ne use and portion
—Od��
CouNy
0
Date signed
Date signed
-��Cd��i: Y .:Q z ,e. .: "' S 's'i� I i ,L?! i., 'L' ° _
�,�r�'`������'�rs?t f,,,STANUARU:DEDUCTION'ALLOWANCE,:,.�.��„�, ;^y� '�y�,"�,�„�"�',.�.,,�z'�-'oi.�F�,��� �
20 _ Pay 20 _
Lesserof 1/2 Homestead S
veWatron or 535.000
Signature of Nid'Rw " � \ Date s'g� �^' O
i.l% �