Homestead_Gottman (2)�;} CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
S�aie Fwm 5473 (R6 / 403)
Prescnbed by �he Departmenl of Local Gavemment Finance
INSTRUCTIONS: See reverse side !or �ling insiruc(ions.
FORM
HC10
YEAR
� � �q�, T7r��
��e� certi(y that on t�ye�tst y oyf� MarcFF?`20� ��
I(We pied as our principal place oi residence Ihe fallowing descnbed real pmperty for which a Homestead Property�Tac Cr�it isu�,eby��m
1(We) owned ❑ Me buying under contract . ry 7nn,
, Have a benefidal interest in the entity that is liable for the property taxes on Ihe property and that owns the property or is buying'un3ef a�ff�ct.
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.r�.i:.���aY,B'��qr �:.�sas'���'_ "� r ��}S,niCONTRACT_:RECORDED���,�����X���-`�i':�Bti��'fi``''d'�+`-� r3.1,'jy��� �<
If buyug an conVact, Fee Simple ownefs name V���^�'�� � OR �
Recadefs afica where conVad is remrdeA Record number Page
Counry
H any portion o
of ihe properry
Tamship 7ating distn , o to shiP)
Legai description Is e Property in 9ue '
�
eal pm ❑ Mobile Homo p.C. biJ-7) .
ar the land not e�cceeding o�e (1) acre ihat immetliatety wrtounds ihat swchire is used tn Oroduce income, desaiDe 1he use and ponion
-�� �� - eo/. G�a-
ravnsnip
I hereby certi(y Ihe above sWtements are We, wved and complete.
Address (num6u and 5Uee4 aN, stafe, ZIP code)
Land not exceeding 1(one) aae immediatety
surrounding residential improvemenis.
Other land
Tdal land (line 1 plus line 2)
Dwelling
Residential fmprovements w Mnually
0.ssessed Modb / Manufa�red Home Garege
Other improvements
Taal improvements (line 4 through line 6)
Total value (line 3 pl's line n
I hereby ceAify 1he above is We, corred, and
complete.
Varifyim� aclbn - SignaNre of Auditor
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(z)
(3)
(4)
(5)
(6)
��)
(8)
SignaWre of Assessor
Date signed
Date signed
. _ _
" � �'�����e�' � e�� �`��e�'"�`��"` STANDARU:OEDUCTIONAI.COWANCE"-i'x'_s��h".e�,?�'.�..:� �-"".�'` �'� '�''�E�.��3``�^.iv`^-+;
- -`-
20 _ Pay 20 _
Lesser of 1/2 Homestead
v�uanon orS35.000
$
SignaWraoflwdilw " Datesigned
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