Homestead_LovingCLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
State Form 5173 (R6I1-03) �
Rescribed by Ne Departmem of Locel Govemment Finance
INSTRUCTIONS: See iarerse side /or filirg inshuttions.
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��e) � � certify that on the 1 st day of March. 20
I(VJe) oaupied as our principal place of residence Ilowing described real property for which a Homestead Property Tac Credit is hereby daimed:
❑ 1(We) owned ❑ Are buying under contr
' Have a benefidal interest in the enliry Nat is liable for the property taxes on the property and ihat owns lhe property or is buying under a contract.
If byMg on coniract, Fee SimO�e ownefs name
Recordefs ofica where conVacl is recor0ed
County
TamShip
Record numDer � Page
Parcel num6er Lepal descriP�on Is Ihe property in 9uestion: �
i�2S-0 0?� �; RealDroperty ❑ MobilaHOmo1LC bf f-n
H any portirn ol the residantlal aW cWre a the land not mcceedinp one (1) acre Nat immediately surtounds that s aure Is used b produce income, describe the use and poNon
of Ue property ulilized to produce income.
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County
Tavnship
I hereby certity the above statements are true, covect and complete.
(number aM street, ciry, s(afe, ZIP cade)
R � %�nV /7U.,
of claimant
���.�''.��'h:i�3;.y'l�:tia,����r3��I!�.,�STANDARU;DEDUCTION'ALL'OVYAMCE;I"x."'A-,'�'y,`�'.;�a��"�'��'�z.,,.,'=�'";�i'%+."`���"'�� ''�
20_Pay20_
Lesser of 1/2 Homestead
vaivanon or 535.000 5
Signature of Audilw ' Date si9ned