HomeMy WebLinkAboutHomestead_Smith (4)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fwm 5473 (RB / 1-03)
Prescribed by the DeDartmenl of local Govemment Finance
INSTRUCTIONS: See reverse side Ior Iiling instructions.
FORM
HC10
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YEAR
� M1e)\ 1�J UI�"�� W V�—�\/ �A Y iC J��� certi(y thaCon the tst d o! arch, 20
..� 1 1 ��
�I(W occupied as our principal place of residence the following described real property for which a Homestead Property Tac Credit �s ' reby daimed:
(VJe) owned ❑ Are buying under contract �S/ / �j
� Have a benefidal interest in the entiry ihat is liable for the property taxes on the property and that owns'lhe property�s bu"ying unde� traU.
;a.3.�.ON Ci`':.�J', Y At I'�tr.•_ ,
It buyinq om m�Vaa. Fee Simple ownefs name
County
County
ofice whera contraq is recorded
Toxnship
Tating
Recard number � Page
�' � /j�N \ �� 1 �/� A� � I�� a�� �� L '�' �' I I �jls N8 GmDe Real WoDertY ❑ Moblle Homo (LC. 61.1-n
� W � W�I '1 1 I
i� w�U 1 W
of the residentlel aWCW re w the land not exceeding one (1) aae thet immediatey wrrounds Nat sUUCWre u used tu produce income, Cescri6e tt�e une antl partbn
y uGl¢eE tn produce i�ome. �. O r' � Q� .
T
I hereby cerlify the above statements are We, cortect and complete.
sbeet, ciry, afate, ZlPcade)
Land not exceeding t(one) aae immediately
surtounding residential improvements.
Otherland
Tdal land (line 7 plus line 2)
Dwelling
Reaidential Improvements or Mnually
A�ed MobNe � Ma^u(acNred Hane Garege
Other improvements
Tdal improvemenLs (line 4 fArough line 6)
Tdal value (Irne 3 phs line n
I hereby cerlily the above is W e, correG. and
completa.
Veri(ying action - Signature oflwditor
Signature o(
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SignaWre of Assessar
signe0
signed