Homestead_MayesCLAIM FOR HOMESTEAD PROPERTY TAX
-"' " CREDIT/STANDARD DEDUCTION
t..» � SMafe Fortn 5473 (R5 / 10-01)
Prescribed by �he Departrnerrt d Lncal Govemment Fuiance
INSTRUCTIONS: See reverse side for filing insfrvcfions.
FORM YEAR
HC10
— I n " �w �
�(1We) ` � 7" 7/ certiy ihat on the 1 st day o( March, 20_
I(We) occupied as our principa ace oi re nce the foliowi described real property for which a Homestead Property Tac Credit is hereby daimed:
� I(We) owned ❑ Are buying u er contrad �
` Have a benefidai inlerest in fhe entlty that is liable for ihe property taxes on the property and fhat owns the property or is buying under a wnUad.
I( byMg on conirad, Fee Simple ownefs name
Recmdefs olfice where mnVacl is remrded
Counry � Tavnship T' g dis (rity, tojGn. townshiP)
/
Pa I umber description Is the
��r5-0 /.3-� �i-3-/�
H any ponion ol Me resitlantiel struqure w the land na exceeding one (7 � ace tAat trn�eCiatary wrrounds
o/ the proPery uGT¢ed fu produce'vicoma. CJ< -7 �
/ �+ �C,(J.2 •
Counly
I hereby certity the above statements are We, wRed and complete.
Address Lnurpperand sheeL rily, afate, ZIPl,ode) _ ,
Record number
Page
al prop�y ❑ Mobile Hamo (I.C. &1.1-n .
is used w produce inama, desmba tne use antl pwtbn
�...'�,`��'$:.•�.`�^"'"�i���..��-__ 'r.,'sSTANDARD!DEDUCTION'AL'LOWANCEt!'��_�..,�'s�`-,�'�z,.?r�.'_ae,.n"",�.�''"�-,'�i`y��:rs'K,s'?���:�,3�.'�-
20 _ Pay 20 _
Leuer of 1/2 Homestead
Valuadon or $6,000 $
Sgnature of Auddw � Date signed