Homestead_Wilson (6)� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� Slate Fwm 5473 (R6 /403)
Prescribed by the Department o( Local Govemment Finance
INSTRUCTIONS: See reverse side !o� Iiling lnsfn�c(ians.
FORM
HC10
u � `�
YEAR
I(We) (,11111iL CY (�1C(L�/�C� L�J //o� C/U certiry ihat on the tst day of March, 20_
I(We) occupied as our principal place of residence the (ollowing described real property for which a Homestead Properry Tac Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under contract
, Have a benefidal interesl in ihe entity that is liable for fhe propeRy taxes on the property and that owns the property or is buying under a conVact.
I( buying on conVact, Fee Simpie owneh name
Remrders ofice where conVaC is recorEed
County
Parcel number
N any poRiJ!�
of Ne properry ulif¢ed tn
Record number � Page
Tavnship Tating disViq (dty, town, townshrP)
Legal tlescription Is ihe property in uestion:
' Real DmpeM ❑ Mobila Homo (I.C. 67.1-� .
sWCWre or Ne land not exceedinp one (1) aue thal immediately wrrounds ihat siructure is used b produce income, describe the use and portlon
cei�ome.
_/%�� -. �i� -�YS`-�Sr%O�/
20 _ Pay 20 _ I
Lesser of tf2 Homestead g
wuanon w 535.000
5ignature of Audilor