Homestead_Mason (2)rt, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
Slate Form 5473 (R6 / /-03)
Prescribe0 by the Department ol Local Govemment Finance
INSTRUCTIONS: See reverse side (oi liling insfn�ctions.
FORM
HC10
YEAR _-
I(We) ��% � � v�.+�y� T tertify Ihat on the 14�. � oi� ar`,�ch, 20��
I(We) u ed s our principal place of residence the following descnbed real roperty for which a Homestead Property T�c G�edit is iereby daim,�i
/
'CI 1(VJe) owned ❑ Me buying under contract M�/,y
, Have a benefidal interest in the enfity that is liable for the property taxes on lhe property and ihat owns the property or is buying Y�"rid�r a�tontra[W17
If buying om m�iraG. Fee Simple ownefs name
Rerordefs ofice where conVacl is recorded
"'- f'Y.'; +s��2—., v °�'9'. 'wY.'s
.,,,�.?.H� �..� r.��I'�?.�_':x-�t��r`.H_ix�
Counry Tavnship
Tacing tlislrict
v
Record number � Page
r nu r v Legal description Is ihe property in queslion:
� O�/ �/� O O ❑ Real property ❑ Mobile Homo (/.C. 67.7-)) .
i( any porlion of Ne residentlal sWqure or Me land not eYCee7ing ona (1 � aae Nat immediatey wrrounds that s W c2ure is used b Droduce income, desaibe Ne use antl portian
ot the property utilized to produce income.
G��- /7- 04 9- 0?00 - DO'j�/%9 ��`-/ ,
County
I hereby certify the above statemenls are W e, corred and complete.
state, ZIP
Land not exceed�•,•• +.�••^�� �^,_ ;�•�•d+��mi.. I
sunounding resi< � � �
Other land �_
Tdal land (line 7
L 5poo aqoo
Residential imprt
Assessed Mobile
�
Other improvem�
Tdal improveme
S� �� 370C�
Trial value (line �� I 11 1 ^� �
Cl �� 6 �J� D
I hereby certify tl �
complete.
Vaifying aclion - Sy .......................
signed
Date signed
�t� �°_•+-`�`�v�"Ovs':.:�aTl�4�F�?.��:r'F'�..,h�ce-c3i=5TANDAR�;DEDUCTIONAL'COWANCE�'b.'�m.'--'_.'-.�,�`+y Ei�;��'�`� a ?:=�;�;.�'.t�,'�-��„�-"y-'
20_Pay20_ - �
Lesser of 1/2 Homestead § _
vauanon w 535.W0
SignawreotNMitw• - Datesyned
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