Homestead_Smith (6)�; CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
t � S�ate Fwm 5473 (R6 / L-03)
Presaibed by ihe Department of Local Govemment Finance
INSTRUCTIONS: See revcrse side /or liling inshuclmns .
FORM
HC10
YEAR
/ . / . � y+ ;i � li—J 1t�
I(We) ^�� , �' M certify thal on the ts�t nda�y� of March, 20
1(We) occupied as our principal place of residence the following described real property for which a Homestead Q}y�rtyFac C�lt1R'IS hereby daimed:
❑ I(VJe) owned ❑ Are buying under wnUact (�,/�/ ///�
, Have a beneficial interest in the entity that is liable for the pmperty taxes on the property and Mat o�e property�r is tiujang u�t akontract.
If byv�g om m�Laq, Fee Simple owners name
where contracl is recorAed
County
Tamship
H any portirn ol the residential sW cWra w the Wnd nat ex e ing one (7 J aae that immetliateh,
af the properry ufiiized in produce income.
aC-�� 08 -,�c� - oa s<.TO_ 9- o�-i
5- 01 b68-Do
Record num6er
disttict (city, fown, fownship)
Page
I Is the Property in question:
❑ Real Droperry ❑ Mobila Homo Q.C. 6f.1-7)
sunounds that sVUCture is used to produce income, describe Na use antl portion
�im�.�.h.
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