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Homestead_RenderR�
� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sute Fwm 5473 (RB 1493)
Prescribed by �he Department ot �ocal Govemmen� Finance
INSTRUCTIONS: See reverse side Ior /iling msln�ctions.
FORM YEAR
` �' k{HC10 �_. [�
�i n 1u �:�J 1S�
AUG 1 � 2003
� . , . � •, � ,-„ .�- �
I(We) 'fy Ihat�on the_1st day of March,20_
r.�, L�� �. _ .
I(We) occupied as our principal place of residence e following described rea property (or which a Homestead Properry T�c Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under wniract
� Have a benefidal interest in the entity that is liable for the pmperty taxes on ihe property and that owns the property or is buying under a conUaU.
I( buying on conVaq. Fee Simpie awnets name
Remrtiers olfice where wnVacl is recardeA
Tavnship
It any ponion ot the residentlal swcWre w the Wnd
of Ne propeAy utilizetl to produce income.
� i i -iii —
ane (7) aae ihet
tlistrict (tlry,
_ V
County � Toxnship � Caunty
Record number � Page
Is the property in que3linn:
� Real praperty ❑ bila Homo (I.C. 61 7)
� s that s IXure is used b produce income, describe the use antl poNon
Tavnship
I hereby certiy the above statements are true, coved and complete. Si n�re�aiman, t �
IAdd ss u erandshee(,ciry;sfate,ZlPcode) 14��
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