Homestead_Lantrip4� ?�'t CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
'� .• j Sute Fortn 5473 (RS / 10-01)
Presrribed by �he Depariment of Lacal Govemment Finance
INSTRUCTIONS: See reverse side Ior /ilin9 insVuctions.
�-.�F '":�'?�;,.'�.54!?-�./ `._*� , � ..'CERTIFICATtONSTqlEMENT"'-: .. .
� (�'e) !.�
I(We) occupied as ur principal place of residence ollowing des ibed real pro rty for which a
�(We) owned ❑ Are buying under contract
ave a bene5dal interest in the entity ihat is liable for the property taxes on the property and that
�� YEAR '
HC10
FORM ,
� �
th5t'bd�heOtSf d�NKMarch, 20_
Property Ta1c CrRQIt is hereby daimed:
v _
r.+4,�."_w �r�^.�4 .�.�.�'�„_ � ..'-k:Ei;w`'�`stF��r=:—' s, s. � ��_,: ==CbNTRACT�RECORDEO-.::�; -'�i � T' =s _tr'� - " .
I( buying on contract, Fee Simplo awners name
Re�fdefs olfice where wntracl is remrded RecorO number Page
Tavnship
� Legal descriplion
Is
�)����/QI I �R, �1proPerty ❑ 61o0iloHe�oII.C.67.f-7)
if any portion ol the resitlentlal sWMure w the Wnd not exceeding one (7 ) acre that immeAiatety surrounds that swcture is used to produce income, describe fhe use antl Oortion
of the properry utilizeA m produce inwme.
_ �/— �? � ,. �/1/ _ /YJ'`7�a2-�
'���� �k���'f��1j;" "�'�.�Yji ��-� �j TRUETAX ����A5SESSEDVALUE � HOMESTEAD' q -•%NON-RESIDENTIAL"� -
�� }�v�s YSz�S50�S�ONLTyat�i. 3�r..,d'-.�VALUE'rz..._.:AT.100°/OF'TTV� �,�VALUEAS�'"=F'�'y�'y,,xi�j,`;-VALUE�;-��-wC.��i
Land not exceeding t(one) acre immediately =1 "� §��k� ."'2�.,+� �;'k�'?y �.�
surroundingresidentialimprovements. (�) e�"',�?�+� ,`•z:,'+r�"�fi��:�
,. ���.� ..y.:co-�5,-w - _
Other land (2) ":;_= 4�$==�;:-;�i
�i:x. -.
..t:�i:,:.. �:-`��'_
Tofal land (line 1 plus line 2) (3�
'- eN ,! ..t h �. r � ,
Dwelling (4) �j w,,, iwr� �"� 1,, y.�,.�'� z.;
Residen6al improvements �`"'` . . �`�''' �'' °� �'
Garage (5) .`*^a a p�t�; �"L�` �'�,�`- � ��:
3"'+Fy'+�"° -c���.':sA�.
�-y
Other improvements (6) ;� �` �fi�� „5�' �
,.,.�3;y.: r�'a
Tctal improvements (line 4 fhrough line 6) (7�
Tdal value (line 3 plus line � �g)
I hereby ceAify ihe above is We, correU, and Signawre ofAssessor Date signed
complete.
Verifying actbn - Signature ofAutlitor Date signed
20 _ Pay 20 _
Lesser of 1/2 Homes[ead
v�u�n or Ss.000
3
Ii •