Homestead_Moxley� s CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
Swte Fortn 5473 (R614-03)
Preunbed by ihe Depanment o( Local Govemment Finance
INSTRUCTIONS: See reverse side lor /iling insliucfions.
-�-, �r -� �:--,
�p �j �I YEAR
F,'�M�../ �
HC70
4
I(We) r certi(y ihat on the 1st day of March, 20_
I(We) occupied as our principal place of residence the following describe real property fo ich a Homestead Property Tac Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under contract �
' Have a benefidal interest in the entity that is liable for the property taxes on Ihe property and that owns lhe propeRy or is buying under a conVad.
If buying om m�trad, Fee Simple ownets name
otfice where contrae is remrdetl
6�-��' ���P7�'�
I( any poRion of the resi0antlal sW qure w
ot the properry util'aed to produce inwme.
coo�ry
Tamship 7 mg d' "(ciry, f . �ownshiP)
L e npUon �/�' Is the rry i questioi
(((� Real pr
� Wnd not exceeding ona (1) aae that immediatety surtounds that 1rucWre is use
�D �� - /D/- G�/. C� ��-/
ravnsnip
I hereby certify the above statements are We, coveC and complete.
(number arM streef, city, stafe,
Rewrd number � Page
nY U �bile Homa (/.C. 61.1-7)
to D�duca Income, Aeuribe Ne use and portbn
``�'�"'���.. /1� S E_ RUS ON Y� �� '� i TRUET� ��'�:- �ASSESSED�VALUE �,HOMESTEAD�x � rNON`��2ESIOENTIAL u��?
��:1.-�:a�{......�,�-�:'�`u����.5+�4,�'�,+�arvYALUE���.�a.� . ATs100%'OF�TN-,� ..�GVAL'11,.E.«� �����;�VALUE.,�.�'����*
Land nol exceeding 7(one) acre immediatety �- "� ��, °+
surtoundingresidentialimprovements (�) ��i�y�'s"'��^�4� ��'��` ��
i.e..� ,xc11'S��.a�'�+.,- 3`�
i i+-!- - a°`r'zq: a .
Otherland �2) �il';����-�i��.c .
:MV1'1iY(.�L"��:::Y^u.
Tdal land (line 7 plus line 2) (3�
:r�' �"Y' '� r�2��,� .""�-x, '-+_�`3
Dwelling (4) ���.c+�.�1..3,,,?`itd��'�.u'��i�¢`��'�.t�`�
Residentiel improvements or Mnually
0.ssessad MobGe / ManufacLUed Harre Garege (5) `i���,i''� _� �r:•��'��
civ'7e � �'.�'�"'c ., . 3•'�- =-
Other improvements 5 c�'���� �£
( ) � °i���
Tdal improvements (line 4 through line 6) ��)
TUa� value (line 3 pl�a line n (8�
I hereby certify �he above i5 We, corted, and Signature af Assesmr � Date sgnetl
complete.
Verifytng action - Signature of Fwditor Date signeA
.. . . _ -.- .- ��t .. �y�+�e�,
�- -�?'��"a�� ��-�"r'�'�'+����3¢�;�`-�'��STANDARD;DEDUCTION'AL'LOWANCEx:�-=.�K ` '�"�-""'"" "'- = � ° -;::
.,w,.�,..xs?L� �`.,Y,-.'{�"wx's<n,. �i.�=v'�s'�.S±�.a�•-«.
20 _ Pay 20 _
Lesser W 1/2 Homestead 5
. ValuaLOn or E35,00p
Sgnature of AudBw " Date signed