Homestead_LearyCLAIM FOR HOAAESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
Stete Form 5473 (R614-03)
Presuibed by Ne Departrnent d Locat Gwemment Finance
INSTRUCTIONS: See �everse side for fili/g insbucbons.
FORM �� YEAR
HC10 �
�..:.F:,:.,.-.._ e..r��s� er"� i,.�'..r-a,�.--.cVCnlltll.A1WN - ItMtNI' ;i•�..35�=.- .._' ..iq'�.a�.r'�ac^...ib�� :=.?.:
I(We) �' certify that on the 1st day of March, 20_
I(We) occupied as our principal place of residence th Ilowing descnbed real property r which a Homestead PropeAy Tac Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under contr t
, Have a benefidal interesl in lhe entiry that is liable for the property taxes on the property and Ihat owns the property or is buying under a contract.
It buying on conirad, Fce Simple ov.ner's name
Remrdels olfice whera conVad is remrded
Counry
Counly
roxnvup
tawn,
�ii�ii iy-T� �.G i-a-id �
I the residenUal sWCture w the land not exceeding one (1 � aae that immediately surrounds that
util¢ed lo produce inmme. / / �
d Zv �
�`:O7/- O�/
Counry
I hereby certi(y the above statements are We, wrreG and complete.
er aM sbeet cd}; s(ate, ZIP code)
�z �Q�rU,� n
Remrd number � Page
al pmper.y Q Mobile Homo (/.Q 67.1-� .
is used to Oroduce income, describe Na use and portion
;��;5�� s.E .� ,.. �. i s- =-•c- �.,� . y ' � . . �- ,y . . _ s
�'..�� �` '� 'iA55ESSOR USE ONLY '��� `'��� � TRUE TAX� - ASSESSED VALUE �+HOMESTEAD NON=RESIDENTWL .�
�'.'�,£`<-+..;�tr._'��y.f?a�:.'sk. �rs��2�',r��.�..VALIlE1„ia..��t'.�AT.700%OF�TTV�.E^;:s_$"VALUE����§��c<�?'.c...VALUE`.�`w.a'^`���
Land not exceeding 1(one) aae immediately ;'z� i�}�{zE+�"°�-�' �t.�S��3i-W�
surtounding residential improvements. (�� ;;�-�',,[�P�{"�°�' y.�n�X��,..-:.
. •�a.S�- �q�' �
Other land (Z) `r�'����,�
+r..r.Jr �..z'(
Total land (line 1 plus line 2) (3)
„ ��, � a x,a����- s...r�#
Dwelling (4) �.� . .' 4`� ,�ii� ��-�
�ResidentialimprovementsorMnuatly �`�^ �`•`� `�� ��"'�"'�'y-''��'
Assessed Mobile / Manufactured Home Garage (5) ������ �� =.�•���
Other impravemenis (6) +���' ��"' u�'�
,a ,��`��
t s.,�,. m
Tclal improvements (Irne 4 through line 6) ���
Tdal value (line 3 plis line n (g�
I hereby certify the above is We, corred, and Sgnature otASSessor Date signed
complete.
Vuitying action - Si9nature ofiWdimr Date signed
��.'."�Y+��'€.�p�_"-'�?= ?�.=.:��i �� t�.�i'��'�4i STANDARD:DEDUCTION'ALCOWANCE �.i!`ss�"�'°i"_ ` s �`'"� £^- v'.`....,���..r:�
�i�..��'-'�: x .r� ._ �5�� � .
20_Pay20_
Lesser of 1�2 Homestead
_ vauauon w E35.000
S
Signature of Auditw " �ate signed