Homestead_Mason (6): �n 7
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION Hcio
Stete Fortn 5�73 (R6I4-03)
Ptmaibed M tlro Depa�fiie�rt af Lual Govemrnent Finarroe �
INSTRUCTIONS: See ie�a�rs afdr b�np iubucriont.
C�-iP�.E�F�"i�i�.,�,-`F'�'''.�.-e`y�'?z'�—��+���.'^,�`"AiR�.^ �-°":�?:`.N�`rCERTIFICATION�STAIEMENT�i:r`r q�.." _< . � -. � w •. * .. -x�y1 .� �.s.;
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I(We) � ��t� th�t � ih�Qdl day of March, 20
I(We) occupied as our principal place o( residence the following described real property for which a Homestead Property Tac Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under contract 6 �
' Have a benefidal interest in the en6ty that is liabie (or the property taxes on ihe property and that mms�ro��r iA�g�11F��nder a contract.
.-�ncON COU
It buying on conVad, Fee Simple ownefs name
Remrdefs ofice where conVacl is remMeO
:i���%��.F����+cY�?ti��i;�'" i�
Counry � Tamship
�j°Cm=`C� � 140 -oo � �
It any portion of the residential sW cWre w the
of the properry uGlized lo produce inwme.
o`�y-3-i l
Rewrd number � Page
Tating disUict (city, town, fownshiP)
Real D�operty ❑ MoWB Hpno (I.C. 61.
na exceedinp one (7) ave Nat immediatey wrtounds Uat swcture is used to produce incmne, descrihe Ne use antl portbn
� ��+--?n�'�ti.=,.� +;#�;t'.M�".ar�7"+'�At``.�i �"`a��-°-,`.��.`�-`STlWDARU:OEDUCTION�ALCOWAl10Ei}�'�'�•�*'��a+�.'i .�-�:..:iCa°�uam'.�:i.:s''s�9ik���'�.'+.�_`.�`s". �•?eYa,'�_°';�
20 _ Pay 20 _
Lesser d 1r2 Homestead $
vauanon a f35.000
SgnaWre oLNidHw ' Dale signed