HomeMy WebLinkAboutHomestead_Hopf� } CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Slale Fwm 5473 (R6 / /-03) ' �
Prescribed by the Department of local Govemment Finance 4 '
INSTRUCTIONS: See�reverse side Iorlling inslructions. �^vn\�� O
��� �
�� YEAR
FORM �
HC10
-."9 Ti S._ '.'_.� �.
��^'e� � � �e�ry�,JUL�,l °�a004Ma�,.zo_
I(We) occupied as our p cipal place oi resi ence the (oi wing described real prope for which a Homes't/ead Property T�c Gedit is hereby ctaimed:
❑ I(We) owned � Are buying under contract /�,�-,�'� ��.-r���.a�,�
�� �iGSr,rar,rn�•.(-v cii^���^
, Have a benefidal interest in the enfity that is liable for the property taxes on the property and tliat owns the�property or is buying�under a conVact.
If 6uying on coniraq, Fee Simple owners name
Rem(ders ofica where coniracl is recorded
Toxnship
�(l-DD�{�d-C� I C
I( any ponion of Ne resitlentlal sW cture w the Wnd
of the property utilized to produce income.
one (1 � aae
County To.vnship
I hereby certi(y ihe above statemenls are We, correcl and complele.
�ECreu (numberaM street, cdy, st.ye, ZI,Pcode) _ . , _
Tmting
Coun�y
Record number � Page
Is Ne properry in question:
�] Real properry ❑ MoWe Homo (1.C. 61.1-7)
unds ihat trucWre is used to produce income, desaibe 1he use and portion
Township
?"�r;��""'.�'�-,���=kae:s.�""Kr� "`�'r .�.,n 3,;�� c5� - �x�� - - - � -�
-..�.. .. �. .
' � 'ASSESSOR!USE ONLY�`�+� '� `b TRUETAX��'�+� ASSESSED VALUE 3 .HOMESTEAD *,Y. �NON�IESIDENTIAL�' �'^iC.,`
�-,_ ;����`*a.,3�, ,yf}sa5�n.�;i�;,,. _ �- .t�,�� � x VALUE� t�5 AT 100%'OF.TTV � �;VALUE "' ;g � �VALUE,"k' j�;��,,, ��.s
.4,.1_ ��t� ,.�.� A-.. ....F?.b ,� .i�"�.SP.+i�� ..��.' C. `��. o-t�c�:'��va,.,.,, ...-.,2�.F �?�eS�
Land not exceeding t(one) acre immediatety =�'�t, ^�`�S�-'�-?�- .�a�-�s��^.
surrounding residenlial improvemenGS. � e` ��rn�-t- � ��`a= ' " '�
( ) � 7 �_sY� '."'d�1,�8.''�.
O�herland (Z) � ��".�^�-�"��-.�-�i'p � � �
.fn:J'`r,*-� �.c .
:....�..-�._e'
TAaI land (line 7 plus line 2) (3�
4 ,33"itR� $4 � '"'G� 1r' ._
Dwelling (4) ;�i pe ,c%'� �.,�'y'�n.3'tt.•*��#
a�:�,�c�� :�li.�`�'��^,xr'�i�C„ �k�y"�A "c`��
RAssessed IMod'le / M eanufactured H aome Garage 5 �c-}� `�"�`. '���s��' F; �r �r°+ =��-
( ) '-��.e`�'�'�?s;�.x�^t� ��f.�'�'�%
�-°'='���y.�{% -
Other impravements (5) �: ?�`�?- �: ;?� �'
: ' i i `�' _s �' - .�_ - - _ 3 ;: :
Tdal improvements (line 4 through line 6) (��
Total value (line 3 plis line n (8�
I hereby certi(y the above is We, coned, and Signature o�nsussor �ate signed
complete.
Vrritying acGon - Signature otlwdiWr Data signed
20 _ Pay 20
Lesser of 1/2 Homestead
SgnaWre
3
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