Homestead_White (6)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
, Slate Fwm 5473 (RE ! 7-07)
� are��me ma
by Deparlmerri of Latal Govemmenl Finance
INSTRUCTIONS: See reverse side for fiGng instrucfions.
FORM Y�R
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I(We),�,Ji/�tiC� �L . !N� certity thal or� tfie'�st �y.M arch. 20_
I(We) occupied as our prindpal place of residence the tWlowing described 2al property ta which a Homestea �p�mty ��edi� isJ�€ie7�18aimed:
�I(VJe) owned ❑ Are buying under contraG
Have a benefidal interest in the enOry that is liable for ihe property fa�ces on the property and ihat owns the property or is buying under a contract.
It Grying on ooniraa, Fee Simple ownefa �vme
offica where wNaC is recordad
Recwd number � Pape
Counry Township Tmdng districl(crty, to:m, township)
Paael number L al descriPlion ��/ %'} � I Is Ihe operty in ques'
1�Y.J S4l /- 3-/ .l ❑ R� ❑ Moa� �� pc s-i. i-n
N arry portion of Ure residerNal sWdura a tlie land not exceedirg orre (1) acre that immedialety wrtounds Ihe� stnictura is used m produce inwrtre, descnba Ure use and portion
of Ihe proparty utiGind b produce imm�e.
��- /�-i9-3oo - 00/.859-0 �/
-.• . ,: . .
County Twvnship County Tawnship
I hereby certify the above statements are We, correct and complete. Si aw , aaima�t
2. � -�
ess (number and 4reet pty, state, antl LP cotle
� O. /� S'b in�. S 4. v� ��•` �" Is 3 3
�_ � . . .. . .
�� ..
LarM not exceedirg 1(one) acre immediatey ;, --c �;; :. r�
surtoundirgresidentiaiimprovements. ��) ��" ;� �- �
O�her land �Z� .,�� '`"�_ r_ '
_:'�;�".
Tdal lard (line 1 plus line 2) (3�
owenirg (a) �
Residential imprwements a Mnually - -
Assessed Mobile I ManufacWred Home _�- -
Garege �g) ' .. . . , '
Olher improvements (6) • _ .
Tdal improvements (line 4 fhrough line 6) �7�
Tolal value (line 3 p!(s lirre � �g�
I he2by tertify Ne above is We, Corred, erW Si6naWre of Pssessa Date signed (monN. day, yea�
complete.
Vaifyirg action - Sipreture of Autliiw Dale signed (month. daY. Y��
�.-� � � • •
20 pay 20 _ qs.ppp for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 12 qq.ppp Tor 2008 pay 2009 41.000 for 2011 pay 2012
Homestead Valuation $
� 43,000 for 2009 pay 2010 40,000 payable aRer 2012
SignaLire oilwdifa Date signed (monfh, OaY. yea� _