Homestead_Kohlmeyer� � CIAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sla�e Fwm 5473 (R6 / 1-03)
PreStribed by the Department d Local Govemment Finance
INSTRUCTIONS: See reverse side Io� Iiling inslruc(ions.
��
FORM
HC10
YEAR
� M�e) � V ��� � certify`;'lhat on��the d st day�of Mard�, Z0�
I(We) occupie s our principal place of resi ence the following descnbed re roperty for which a Homestead Property Tac Credit is hereby daimed:
❑ I(VJe) own d ❑ Are buying under contracf � � T Q 1 2004
� Have a benefidal interest in the entity that is liable for ihe property taxes on the pmperty and tliat owns Ihe�pmperty or is buying under a wnVaG.
I( buying m contraq, Fee Simpie owneYS name
Remrders olfice where conVact is reoorded
Caunry To.mship
P�� - S8� � .
I( any portion ol the residential sW cWre ar the land nd
of Ne properry uL7izetl b produce inwme.
- oU3
Record number
(ciry, rown, township)
Page
y� �^ �I� I Is ihe property in 9ueslion:
11 ` ❑ Raal pra
, perty ❑ Mobila Homo (I.C. &7.7-7�
one (1) acre that immediatery surrounds that swcture is used to produce income, deuribe Ue use antl portion
5 � p,`'
'�;�,w,t��'�,'�� .�,�, ��;sTarroaao!DEDUCTION�nLLOwnr±ce�����`�,=���-�i��i'��,'�„�'��� W�
20_Pay20_
Lesser of 1/2 Homestead
vauauon or E35. WO
S
SgnaWreoFNiEilor � Datesigned