Homestead_Wright (3)I
.,.
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
S�ate Fortn 5473 (RB / 403)
Prescri6ed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverso side Ior liling insfmctions.
FORM
HC10
YEAR
I(We) C , � /\ � certifyth�fbh�theWs(d5y�o�fRAarch.20_
I�occupied as our principal place of residence the following descnbed real operty (or which a Homesle/a,d Property 7� Cr � is hereby d med:
I(We) owned ❑ Are buying under contwct ( �J \
4-�
i Have a benefidal interest in the entity ihat is liable (or the property taxes on ihe property and Nat owns the;�rg�¢7fj o?°is.Gu�n�c��contract.
I( buying on conVap, Fee Simple owners name
Remrdefs ofice where contract is
County
Parcel number
tiv.� — v cJ (,y) �
N eny poRion of Ihe residential slaC
ot Ue p/ �'6�o�ce im
��vy/S9-
Twvnship
Legal dascription
:Sl,� �5� / 7-,� _
Tating Qistrict (Ury,
Is �he
Record number � Page
ae� o�ooem ❑ Mobila Homo O.C. b1.
eaceedi�g one (1 J aae that irt{mediatery w unds that s cwre is used b produce income, desaibe the use and portlon
w ��:: L
�}`�.�+.h
Toxnship
- �" /
I hereby certify ihe above statements are We, corred and complete.
Address (n�m6er aM sGaet city, atate, ZIP cade)
County
al
Tavnship
_.. .`�.sc&v' �''� ;.�"T�'�'',k�"`�'-��7"ii'��.?�;i�,'{aSTANUARU;UEDUCTION'qLLOV1IANCE:z3:,�1�.�a��1�xt:'w�-�' a�s,�*'�uSr'.2�-;:�'+�'�'r`��,'��'.i�".s�`_,.�.:.`;�+","�-�_",..F
20 _ Pay 20 _
Lesser of 1/2 Homestead
vaivatron a E35.000
$
SignaWreofAudriw � Datesigne0