Homestead_Head�� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� State Fwm 5473 (RB / 4-03)
Prescribed by the Department of Local Govemment Finan�e
INSTRUCTIONS: See revcrsc side /oi liling instruclions.
FORM
HC10
YEAR
�M'e) ��fJIS(JCJL–T N/LJLd! ���(LL.(X certi(y�2ho �et�stday-HfMarc��20—
I(W�cCUpied as our principal place of residence the foilowing desuibed real property for which a Homestead Property;Tac Credit {s.hereby da ed:
JI(VJe) owned ❑ Are buying under contract � �l ���—/
' Have a benefidal interesl in the enliry thal is liable for the property taxes on the property and that owns lhe property,�� buyibg ur%14�a conVact.
G LUO
�
If buyinq om m�Vad, Fee Simple ownefs name
Remrdefs olfice whera conVaU is recorded
Cainty
�
It any portion at
of the property i
Tamship
Tating
G�BSOP: r�.U`:TY A1�0! �y �
Record number Page
���,'L'9a��PU� 7'.3—�� �%/0.G Itsth�ProOenY��Realp Pert� ❑MobileHOmoll.C.bf.f-n
fV
sWqure or Ue land not exceeding one (1) aae thal immediatey surtounds that swGure is used b produce income, describe the use and poNOn
�ce iricome.
�iivi�oiiv�
1 hereby certify the above statements are We, wvecl and complete.
_ Q� �nu�be�nd s7ree4 �; sfaf , jlP.Fode) / I
�. � 7CiCiCJB'�� Vi lL�
Land nol exceeding 1(one) aae immediately
surtoundina residential imorovements.
Other land
TUaI land (line 7 plus line 2)
Dwelling
Residential improvements wMnually
0.�e�ed Aloblk � Ma^ufac4�red Home Garage
Other improvements
Tdal improvements (line 4 fhrough line 6)
Total value (line 3 phs line �
I hereby certify ihe above is We, corred, and
complete.
Vrrifying action - SignaWre of NidiWr
I�1
IZ)
(3)
(4)
(5)
(6)
(�)
le)
Signawre of Assessor
�K1
Date signed
Date signed
`"�.`�"��,°�,t���''��,��!�;?�ST/WDARD:OEUUCTION'ALLOWAHCE, �'!:��""�'�� ` � �'
. n� .i�`��w`'iva--?,�.�.'�3L.: �S°'���:s�`�.4`3�'.�s`A`�?3�*2;,
20 _ Pay 20 _
Lesser of 1Y2 Homestead $
veivanon a f35.000
Signature oflwdilor " Date signed