Homestead_Mauck�; CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
� State Fwm 5473 (R6 /4-03)
PreSCribed by the �epartment ol Local Govemmenl Finance
WSTRUCTIONS: See �eversc side lor /iling ins6ur,fions.
FORM YEAR
HC10
1� l '� � .
� � i�_-/ i_a ��
� M�e) i _certify that on the 1sl day of March, 20_
I(VJe) occupied as our principal of residence lhe (ollowing descnbed real property or which a Homestead Property T�c Credit is hereby daimed:
v
. �. .
❑ I (VJe) owned !ve buying under contract �"� "`"�' .( �• C�- -
• Gigcpp� �- � , .,
, Have a benefidal interest in the entlty Uiat is liable for ihe property laxes on the property and that owns lhe property or is buying under a wnVact.
counry
number
Tavnship
destription
the Property
� Q /�/ � I�/y" S� K(� ) �d — 3- �� I Q� Real D�opery ❑ Mobila Homo (I.C. 61.1-�)
I( any portiw� of ihe resitlentlal swclura or Ne land not exceeding one (7 � arre that immediatety wrtounds Nat swchire is used lo produce income, descnbe Ue use antl portion
of the properry utiizetl to produce inmme. �.��
�
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=�,:.-N ��_ �:�. � ��.�-,� - -- _ _._ . _- .. - - - 5 �, .., ;. �„��.
_...�x��-.�. � -���:7�?:...:::.FF�FROP.ERIY;OWNEDiBYCL'AIMANT:IN,'OTHER'COUNTIESfi,'r,1",.�,...__,.,r:ii�",:��..�':}�1Ee.�j{?`?�:;:
County Tawnship County Tawnship
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I hereby cerlify the above sfatements are We, corted and complete. � a ure o ifn�f✓ /�. /// //
\!�!/i7fi/ (/
Address (num6er aM sbeet, ciry, sfate, ZIP code)
� �''�� ASSESSO�R USE ONLY-.�'�� ��z�� 1�'��?RUE TAX �w� � �ASSESSED VM.UE �' HOMESTEAD�'� ; � NON E �OENTIAL�✓?�° �R
{��.;. "� fi<�",. '_�. �.� . - 's� '.=u =Y-�..u.VAI:UE�y7`u�� �. AT 100°h�Fi,,T'TVk �i�uVAUJEr� ��. .�.��:s.VALUE�.c.�`n"'"�t`or���
Land not exceeding 1(one) aue immediately �- s�st.�-�;��I.��F"r.�-�,°s��,�
sunounding residential improvements. (� � �S� `-�`�r��r;�"�`��:
Other land . " SY��`' w
(2) �":�
:�`����.��:d;
Tdal land (line 7 plus line 2) �3�
.s�+',��"q`,� �'ii.? �ti �s�t "s
Dwelling (4) `+'�' -�""'�i.�_ � �,f .. . '-..
Residentlal improvemenLS or MnuaAy
�;�.�.�mFaS.�' }.:3�;..�x.�.�_ax.�#
Assessed Modle I ManufacWred Hortre Ga2 e � fi-'��`,��' �.�'� ^��. .,
9 �5� ��3w����` ��
��;�:y� .��>
Other improvements (6) �.4:�-�• i�-� �`.
?;'�-3f,'.'•'?�'.�ra:_
Tdal improvements (line 4 through line 6) (�)
TUaI value (line 3 plus line n (g) s
I hereby certify ihe above is We, coned, and Signature ot wssessor Date signed .
mmplele.
Verirying actbn - Signature oflwditor Date signed
Le�ser of 1/2 Homestead
vawaUOn w 535.000
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