HomeMy WebLinkAboutHomestead_Klem; CLAIM FOR HOMESTEAD PROPERTY iAX
CREDIT/STANDARD DEDUCTION
t � State Fortn 5473 (R6 / 1-03)
Prescri6ed by the Departmenl of Local Govemment Financ�=
INSTRUCTIONS: See Bverse sidc lor /ilinq inslruc6ons.
�pj
FORM YEAR
HC10
�y � �
.�{. -N*' e} ��
�'� f? �lt . (�J ��
(� �� N _
��e� � certiy that on lhe 1sl`d y of March, 20 rn/
I(W ) occupied as our principal place of residence the following es �bed real property for which a Homes�ead Property.Tmc Credit is hereby daimed� V
/�.�i1 '''1
I(VJe) owned ❑ Are buying under coniract �1 J �'_ �`�,, �,�„
' Have a benefidal interest in the entl that is liable for the ro e taxes on Ihe ro e ��~ ''
�Y P p rty p p rty�and that owns ihe property.or�s'buying under a contract.
If buying om m�tracl, Fee Simpie ownefs name
Recordefs oifice where coniraq is recorAed
Parcel number
riir�.�i��r�:��+
To.mship
descnption
I( any portion of ih0 residenlial SWdure w Ihe Nind not
ot the properry utilized lo produce income. n l� .
Taing �islrict (dry, town.
Is the properry in question:
�Real prop
Record number
❑ Mobile Homo
Page
61.
one (7) aae that immediatety surrounds ihat swcWre is used W produce income, desaihe the use antl portbn
3
- aa-�3�s- Q�1
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,ve_>�`.4''�`�',�m1���Fx`�rv�*���..- ��'. .�'�Tt��.-':STANDARD:DEDUCTION'ALCOWANCE�.��:,'�`,+p'„��.��,,.�,���*:fC���t ,E �3�`� �w=
. .. _ -- - - �'` t'�t�`�. �
20_Pay20_
�esser of 1l2 Homestead $
vauauon w E35.000
Signawre of Auddw � Date signed