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� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (RB I I-03)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side /or Iiling instmc(ians.
FORM
HC10
YEAR
I(We) �]�X�/�Jl� 7�����{/�1�],% %�� certify that on the 1st day of March, 20
I�(VJe) occupied as our principal place of residence the following described real property for which a Homestead ejQyqrtylT� C�� hereby daimed:
❑ I(We) owned ❑ Ne buying under contract /
� Have a beneficial inlerest in lhe entity that is liable for fhe property taxes on the property and fhat o �lhe prope[t��br is�ying ur�r �gontract.
I( buying an conVaU. Fee Simple ownefs name
Recordefs ofice where conVad
Tavnsnip
-��Q�-D�5//-(X� � °�
H any ponion of Ne residential sWCWre w the Wnd not
of the property utiized tn produce income.
'/ /�ol!/u'
�w'��=�.:.`_-�F
To.vnship
Record numEer � Page
Tating distritl
Is e rty in question: �
� �-3��p� ��Real property ❑ Mobile Homo (I.C. &/.1-'n
one (1) aae that immeaiatety surrounds that sWUUre is used to produce income, describa Na use and poNon
� ��' Do��
I hereby certify Ne above statements are We,.conecl and complete.
8M SiIBBi,
Counly
1.
Tavnship
20 _ Pay 20 _
Lesser of 1/2 Homestead
yaua�n a E35.000
�
D`�tes�rled /�I�
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