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� CLAIM FOR HOMESTEAD RROPERTY TAX
F CREDIT/STANDARD DEDUCTION
t I 54te Fwm 5473 (R6 / 4-03)
' Presrlibed by Ne Departmeni of Local Govemment Finance
� fNSTRUCTIONS: See reverse side for filing instnictions.
FORM
HC10
YEAR
�=1�i�c -i`--=- tr,3.i..i?Y?i7K_:'+'?v�': - F's �':�;�;�'a,.-(:CKIIYI{:AIION STATEMENT;:' ' ' _
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I(VJe) certify that on the ist day of March, 20_
I(VJe) occupied es our prindpal place of i ence Ne foliowing described real prop for which a Homestead Property Tac Credit is hereby daimed:
i�I(VJe) owned ❑ Pre buying un r contreci
Have e benafidal interest in the enUry Nat is liable for Ne property taxes on the property and Nat owns the property or is buying under a conVact.
I1 buying on conired, Fea Simple awnefs nama
Recorders ofice where conVad
Coumy
Paul number
If any portion o
olthe property
a
Is
e:ceeeinp one (1) Lacre at unmediatey surtounEs
a°Y� ag��
O`� n l
�'\
tovm,
Rewrd number � Pega
al properry ❑ Mobile Home (I.C. 61.1-�
is used to produce income, describe tlia use and
._. . ,. -
'_':F�..r����,z.:� -_:�'�`:�z�Sx��_k�`?'.,',�;P,ROPERT,Y0INNEDiBYCL`AIMANT;IN`OTHER'iCOUNTIE3ti�3>cu`�`"'`;`a .w'�'�,�fi>4_ _:.��.rt-.;t,°-^'
County TwvnshlD Counry Tv.vnship
I hereby certify the above stetements are We, correct and complete. Signamre ot ciaimant
resa (number and sVeet, tiry, atate, ZIP oode)
�''�, � a` -`'� " ��#'" y c6?s y , '�� i'"TRUE TAXt'�� AS5ESSED V/1L'UE HOMESTEAD � �� ` „` NON RESIDENTIA�+u ' ``
,;,��� �ASSESSOR�USE ONLY ,} �X, �� ���i� - t,�S.k�iVALUE,'-�s �- !AT�100X OF,TN ,.r r.;VALUEz.r � �� �'s �+:.=
.:S _-r,� �.a'�-�?: sh *a. � . i� ari+�. e t-_ . I .� �e� VALUEt .
Land not exceeding 1(one) acre immediatey n�,�2� "e`�-� , �};� w�� ", �_"
surroundin residential im rovements. ��� � °-�.-}'� � � ; i: �-
9 P _t,.-< .��#:`c;�a'.�c�.::''� .:.-z�,'
s':
Otherland (y� ` '�." � . '
- <�.f.
Tatal land (17ne 1 pfus line 2) �g�
L.ui. h #�lci�� r,c �u'L:l:'sCty.�N. �q
Residential improvements orMnuaily �elling (4) �,�.�r�a;°� y� y _, r.uS�
Assassed MoWle / Manufadured Hwne Gara e � u��'' "x�" �..
9 �5% '?' � �.a Yz-�. y � r�
?:>=..-i �
O�llar improvements (6) :-� ?;+.'�. . :,
:+,-i. •,a., �r �
Tdal improvements (line 4 through lirre 6) �7� .
Tasl value (line 3 phs line n (B)
I hereby cerlify the above is We, correct, and � Sig�awre otpsseswr � Dau signed
complate. � .
Verifying action - Slpnawre otAUditor Date signed
y �3�,f`..,':�;Y��°�`.'Fs..r'r��ir`w'ir��`.ti �'f�f � �`.%".';?STANDARD;DEDUCTIO_N'ALLOWANCE � _., :..�'� � . .ti � u
.i
20 _ Pay 20 _
Lesser ot 1l2 Homestead
Valualion or $35,000 �
SlBnature oflviditor Date signed q
V-
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