Homestead_Wathen�• , CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
State Fwm 5473 (R6 / 4-03)
Presrnbed by the Department of Lacal Govemmenl Finance
INSTRUCTIONS: See reverse side lor liling instmctions.
I(4Ve)
FORM
HC10
YEAR
certify that on tfi��1'sl � of 14A�d1�, 20_
I(We) occupied as our principal place of residence fhe (ollowing described real property for which a Homestead PropertyL�s hereb�
❑ I(We) owned ❑ Are buying under coniract
� v
Have a benefidal interest in the entiry that is liable for the property taxes on the property and Uiat owns the prope?l�w:f'sly�y�•�ds'r�a[�con�raQ:
If buying on conirad, Fee Simple owners name
RemNefs otfice where mnUad is remrded
Counry
Tavnship
Record number � Page
Tacing dislrict (city, fown. fownshiP)
Ihe properry in Queslion:
r
r ❑ Real praperty ❑ Moblle Homo (LC. 6f.f-�
If any portiwi of Ne resitlential sW cWre or the land not axceeding a�e (1) aae that immeCiatery wrrounds Ihat swc4ire is used b produce income, desvibe the use and portbn
W the WaPenY utilaeO b produce i�ome.
"a��-o��
'�"�"�' ��' �`��'''�E'` �`��� ga����� k' TRUETAX �� �ASSESSED VALUE �+HOlAESTEADa .��! NO E f�ENTIAL�O j=h
�,��r�— e �ASSESSOR USE ONLY'
��'�,�,R�"�;u�,� r�g��,.� �. ��''�'�'�VALUE�,��.'�AT 100�/.OF�'TN� �.�VALUE�� �����-�?�VALUEc-_'e'a+. Y '�'�r?
:
Land not exceeding 1(one) ave immediately ��; ,`�£.��.��'��3'xH.^�
surrounding residential Improvements. (�� � �".s�� "'� ` s ' �''
,....�.., 4�5�,����+'�`_-'�`
Other land (2) �s��+",'- _�.:'�°�`���
:•r:aetl e.-���.�� ^re
Total land (line 7 plus line 2) (g�
. �„��, � °�.,r�-�
Dwelling (4) �" � .�'�e- '� �
Residentiel improvements wMnuaOy ���^``k���d � �µ��` ��E
Assessed MloWle / ManuFacWred Hortre Garage (5� ��"`'�`' � .' .ti', %� �' '.
,��'i.t�+��• �.•�` 5"�.-'.-�`.s�s:c�.���
����� ,±`�
Other improvements (6) r�-� , , '�
' s:.+.�:,�I'�'�'u:;��sr
TUaI improvements (line 4 fhrough line 6) (�)
TUaI value (line 3 phrs line n (g�
I hereby certi(y Ihe above is We, corred, and Signamre otnssessor oate sgned
complete.
Veriryirg action - Signature of/Wtlitor �ate sgned