HomeMy WebLinkAboutHomestead_PellCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} CREDIT/STANDARD DEDUCTION HC10 �
/ State Fortn 5473 (RB / 403)
Presaibed by the Departmenl U Local Govemment Finance ____ . .
INSTRUCTIONS: See revcrso side lor liling insfmclions.
I(We) I�� ?� J d-1'�j.�l,�,u_ f�} t' � �eNfy thal on Ihe 1 st dn y oflGfaF�, 20_
I(We) occu ied as our principal place of residence the following des ed real property for which a Homestead Roperty Tac Credit is'hereby daimed:
� I(We) owned ❑ Are buying under contract J
� Have a benefidal interest in ihe enli that is liable for the ro e taxes on the ro e and thal owns the m e �oi fs bu � n under�
�Y P P rtY P P hY P P nY Y� 9
If buying on contraq, Fee Simple owners name
Remrdefs ofice where mnVad
Record number � Page
s�. �-�•^- . _' __ __. _ . __ _ _ _ .
��� �,��.*�`�',s°'.� ���,���'��9P,ROP,ERTV:OESCRIP.TION,����.'�".��'���,.�:�;ri;.��`��i�s%��:�.ci
County � 7o.mship Taing disfrid (ciry, fown, township)
P r �(f ..�') � L e (/'f. . � Ne Properry in queslion:
� S�+O {;�(J � �J � ❑ Real property ❑ Mobile Homo (LC. 6f.7-n
N any poAirn ol the residenllal sWdure or Ne IanA nd exceeding one (7 ) aae Nat immediate11yy wrrounds ihat sWCture is used to produca income, describe Ihe use and portion
of the WaP�N uLLzed tn produce income. �`� �
o?�-�� -a� 3�-�r.r�. �3v-��-
?"a��,�"�.s,x .'�w+s-�-, `�_-' :k.�w'""���?�P,ROP.ERTY;OWNED BY:CL'AIMANT,IN'OTHER'COUNTIES,FE`�`„�,.g-;,'�5',�.1��1��i'�3�.�-.�sr��'R.'S``���.e
County Township Counry Twvnship
1 hereby certi(y the above statements are true, correct and complele. Sig ture ot claimant
�
r eiM t, city, stafe, Zl� y� „ n �����
�3 H / w.L�i,e e�i
� "�' ��'�`''�`%�'� � '' -�r' + �TRUE TAX � ASSESSED VALUE 'AHOMESTEAD� tNON=RESIDENTIAL �
ASSESSORUSEONLY �`"�^ ,py(�UE� `"' �AT�100%OFTfV VALUE � VALUE'�'��� '
3... .��efi.i3 _St#�3�`r"em`° 'Sb��..�.� �_......L.��`' ,a. -�-, a`.+...,� a�''��Y. � .�.�' ��Ga.'�.L�'-:...� ...,.o-ti^n�
Land not exceeding 1(one) aae immediatety ;?�� i�y!�+,�,�•���,. �s�r�y.�
surrounding residential improvements. � (� � •:''�. `�'��,ti° T"'���,� � � � ��
�, a�� r.�.� � �
Other land �' ts
(Z) � �� a :
..e.��:F,, �,:'
Tdal land (line 1 pfus line 2) (3)
�' w'� ` ' �e'T ��-.-��.��v�.,�F
Dwelling (a) �'�,,....,,��'rv�a�� r.dr��c,� �xfi.�s�•`�
Residentiel improvemenffi or Mnuatly fi �.�� ��� F^,
Assessed Mahila / MerwfacNred Hane ��9e (5� +��'r �� .'..: ,� � �` '�.o�-�
•v:S�'3'. iY
ONerimprovements (6) ��:'���♦�"�}�� ��
Y l �.5�.�'�Yiro �
Tdal improvements (line 4 fhrough line 6) (7)
7ctal value (line 3 phs line n (g�
I hereby certify the above is We, corred, and Signawre ott.ssessor Da�e signed
complete.
Verilying aclbn - Signature ofAUtlimr Date signed
_-� 1i' � ____