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Homestead_Williams�� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� State Fortn 5473 (R6 / 4-03J
Prescribed by Ihe Department of Local Govemment Finance
INSTRUCTIONS: See revcrse side /or Iilinq insVUC(ions.
FORM
HC10
YEAR
� cwe) �,<(�(Q �L.O �%�/ll.L`rC�%a..U%%L��� 0 t; f�7 2003
certiy that on e tst day o( March, 20_
I(VJe) occupied as our principal place of residence the (ollowin described real properry for which a Ho�Itead Prope T�yredit is/h/ereb�/y daimed:
❑ I (We) owned ❑ !ve buying under contract /L�"/`��""" "J "' / � _ " I
' Have a benefidai inlerest in ihe enti Nat is liable (or ihe ro e �axes on the ro e and that ownsihecnoi r� � iNT �� i�17
h P p�1Y p p rtY pr p� or is btFying u�d r a wntraU.
I( buying on conVaG, Fee Simple ownefs nama
Remrders ofice where contract is recorded
Counry
Parcel
Tamship
Legal
U -VlO
H any portian of Ne resitlentlal sWdure w Ihe land not ex ing one (1) arre that
ot fhe properry uGlized b poduce irimme.
County
— // � / _ / U� ' Ul/
Tavnship
I hereby certify the above statemenls are W e, wrred and complete.
ci(y; afafe, ZIP code)
Land nol exceeding 1(one) acre immediatety
surtounding residential improvements.
Otherland
Tdal land (line i plus line 2)
Dwelling
Residential Improvementa a MnuaOy
Assassed Mobile / Manufac4ued Home Ga2ge
Other improvemenls
Total improvements (line 4lhrough line 6)
Tdal value (line 3 plw fine �
I.hereby cartify the above is W e, corred, and
complele.
Vairy"ug aUion - Sigriature oflwdilw
� nSU�� I
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��TRUETAX��'�
f.�.tV.�u, ��i.._..
i�)
(Z)
(3)
14)
(5)
(6)
I�1
(8)
SignaNre ofAssessor
fown,
CG��
Record number
queslion: ' /'
V
3oal praperty ❑ Mabile Homa (
�e is used b pmduce income, describe
Toxnship
signed
Date signed
Page
and portbn