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Homestead_QueenA ^"iv
, t CLAIM FOR HOMESTEAD PROPERTY TAX
- � CREDIT/STANDARD DEDUCTION
` •,• � Sfate Form 5473 (RS / 70-01)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side lor filing insiructions.
�
FORM � YEAR
HC10
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� M�e) � certify that on the 7 st day of March, 20_
I(We) o upied as our p� ipal place of residence the followi escnbed real property for which a Homestead Property T�c�G(ed�t � h�B�Gaimed:
I(We) owned Are buying under contract /�
�ave a benefidal interest in fhe entity that is liable for ihe property taxes on the property and Ihat owns the prape�rtyc o�6iy��u �r a conlract.�/
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�s9.4a�:c:+r�v�k-��.��w'�r��=.�'�`—��""�'�-�?'�.`��"��>CONTRACT',RECORDEDxac�i: �� i�x:�..s'ra�i�.�':�t:-:?e� oE�. ri-�:,.�° . � -
If buying on conVad, Fee Simple owners name
Recordefs olfice where contract is recorde0 Rewrd number Page
Counry Tavnship Tacing tlisl � Iy, wn, fowns '
Py)r r �L�\q al description Is the property in questio .
/ ^ o�3 � a V eal pro ❑ Mobile Homo p.C. 67.1-7)
I( any potlim of the resitlentlal sWClure w Ne land not exceeding one (1) aae that immediately surmunds Ihat sWCture is used to praduce income. describe the use and portion
of ihe property utilized m produce ifxome.
G-//-3/- �3c�o - ao�3�a - o�t �
20 _ Pay 20 _
Lesserof 1Y2 Homestead
Valuati_on or 3�.000
5
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