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CLAIM FOR HOMESTEAD FROPERTY TAX
° CREDITISTANDARD DEDUCTION
t Stata Fwm 5473 (R6 / 4A3)
� Prescribad by Me DepartmeM ol Local Govemment Finance
INSTRUCTIONS: See ravarse side for �ling inst�ons.
FORM YEAR
HC10
��e) certity that on the tst day of.,March, 20_
I(We) occupied as our prindpai place of ence the following described real property for which a Homestead Property T�c Credit is hereby daimed:
e) owned ❑ Pre buying under contrect
Have a benefidal interest in the entiry that is liable tor the property lexes on the property and that owns the property or Is buying under a conVact.
If buying on contraq, Fae Simple ownets name
Racordets oflka whera conUeq Is remrded
t.i.� ��`'*a'n'�������.f Vxe�.3i
Camh Township
P nu ber Legal
�-a�sab-w ��
If eny pwtion of Ihe resldential structure a Ne IaM
N Me property utl(¢ed W produce incane.
�.//� �% �
�a
one(1)1 th�(immediatetysurtounEs
�
Record �umber � Pege
� vroaem u Momie r+ome �i.c. s,. �-n
is used to prvduce income, dascribe tha use end portion
, ' _ ' '_ _, -- - _ . — . -:x, ..
.'-.� �-�'�;cr�'���Fr�'�PROPERT,Y.�OWNED`BY�.CLNMANT.IIJ OTHEiiiCOUNTIE3�`r F�''; , '� `�.,..'#�,,,-� ,u �"�` �'
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Counry Tw:nship County Twvnship
I hereby certfy the above statements are We, cortect and compiete. Signature ot Gaimant
ress (numbar arM sUeet, ciry, atate, ZIP oode)
°'� ��� '}'� ASS SOR SE ONLY�.,`-��-'y5��k"`�'� �� S��' TRUEaTAX� �� ASSESSED VAl'UE HOMESTEAD x:� � iNON RESIDENTIAL � ���
��.�.�`�`rab`�.��i:'' �"r��rN?i���'�r::-�`�F� � s�`�.;.,.`�i^i.VALUE'�'F ..? "AT:.�OOX,OF��TN ..a.VALUE4� �. r? .y: cVALUE _.°.,,�s�' 4�'.
Land not exceeding 7(one) acra'immediatety '; n�� -�� J:;��T ,��
surtounding rasidendal improvaments. (�) �„x .r �F;w.a;¢�,#s t � " - ��
Other land �p) ��"�� ' ,.5.,..R -
Ta[al land (Ilne 1 plus Ilne 2) �g)
Residential improvements or Annuairy �Iling (4) ; E� �� r��_�r;a .�� 1�
Assassad Moblle / ManuFactured Home ��9e 5 ' :� t-�',.,�w!� ,� t��t' y i.�;
! ) ?% -!�.,.:>1:��=�'� . �.. �.'
;� � _ '
O�qe1 improvements (6) .,. ; r .�
9 h'
Taal improvements (line 4 through line 6) �7)
Tctal value (llne 3 phs line n �g�
I hereby ceAify the above is We, CorteCt, and � Slgna4ire otPSSessor - Da[e signed
complete. �
Veriymy eWon - SipnaNre otAUditor � Data signad
�:_ `.�+'�.�'✓{}.'+�*, t'�-.�i:�SS-�` +"£c-�`Ie�Yxit:°-t �c-.�.yz�:�5TANDARDIDEDUCTION'ALLOWANCE� :`� < -. . `' .�- .
20 _ Pay 20 _
Lesser o( 7Q Homestead 5
Valuation w 535,000
SIBoaWre ofPUditw Date si ned� l�
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