Homestead_Kell,� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
t � Suie Form 5473 (R6 / 4-03)
Prescnbed by the Department d local GovemmeN Finance
INSTRUCTIONS.- See revcisc side Ior liling inslruc(ions.
FORM YEAR
HC10
��e) e�fy�at n Ne�ay t M . 20_
I(We) occupied as our principal place of resid ce the following cribed real property for which a Homestead ro i by daimed: �
❑ I(We) owned ❑ Are buying under contracl FEB 2 2 2005
� Have a benefidal interest in lhe entiry ihat is liable for ihe property tazes on Ihe property and �hat owns the property or is buying under a contract.
�
c:FS'w -.a.:�^'".ifi ?.r_=.'i ..r,c:.'�:..i'` CONTRACT.iRECORDED=:.-.. _ .�. .�. '
- _ _ - . r�acn.�'........ .., . . . .
11 buying on convad, Fee Simple ownefs name
Recorders ofice whera wntract is recorded
Tavnship
Tacing district (ciry,
Remrd number I Page
Parcel nu�mber I Lega�n�M� ��— �/ /' C I IS �e P�Perty_ in ues1ion: � /�\,
.('1 • ...
(/ �- 2�S7-o J rti �� �rJteal pmverty Mobile Homo.jlY 61J-7)
II any portion ot the resiAenlial sUUCWra or the Wnd not ezceeding one (1 � acre that immediately surtounds thai s ure is usetl to D��uce income, desuihe ihe use antl portion
at tha proPerry utllizeA to produce inwme.
—�O'�7—n>�-0�.
.%1Ta+Fi-� .�">'�: `rFROP.ERTYOWNEDBYCLAIMANT�IN.0
County Twvnshfp Counry
I hereby certify the above statements are Irue, covect and complete. �9 ure ol
c
ACtlress (number and sVeet, city, stafe, ZIP tode)
"� i�-wxij��..:ja� '
Twvnship
'p�v''��v s4i' ASSESSOR USE ONtY,, .. �� : TRUE TAX : ASSESSED VALUE : HOMESTEAD� ' NON-RESIDENTIAL„
s,�a,. . .,{_L��'a..,�?-� . - VALl1E AT100%OF�-TTV- VALUE'' ?,`VALUE�� .
Land not exceedmg 1(one) acre immediately - -- �.
surroundmg residential improvements. (� � . . �
Otherland (p) - � .
Tqal Iand (line 7 plus line 2) �3) '
Dwelling (4) y i :,
Residential improvements or Annualiy ' �'
Assessed Mobila / Manufachued Home Garage �g) �: ,:^—�;=�:.:.: r�;:: ;.: __
Other improvemenis (6)
TUaI improvements (line 4(hrough line 6) �7)
Total value (line 3 pl�s line � (g�
I hereby certify �he above is lrue, correU, and Signamre o(.�sseswr Oaee signed
complete.
Venfying actbn - SignaW re oflwtlitor Date signed
_ - �- = =STANDARD DE�UCTION
20 _ Pay 20 _
lesser of 1/2 Homes:ead
vauauon or E35.000
5
Date