Homestead_Burek.,.
� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
/ Slate Form 5473 (RB / 1-03)
Prescri6ed by ihe DBDartmenl ot Local Govemment Finance
INSTRUCTIONS: See reverse side /orlling instructions.
FORM
HC10
YEAR
I(We) � yF- � l�J��IIL- L certify that on th7e�4s�t day of Marl1clh 20
I(W�upied as our prin ' al place oi residence lhe following described real property for which a Homestead Property Tac-Credil is here�i3daimed:
I(We) owned ❑ Are buying under contracl � � %% n
/
� Have a benefidal interest in Ne entity that is liable (or ihe property taxes on the property and that owns the propertgwis�buying.under�a�contraU,
�' G3SONCC�:tT�. ..�'^,_� ,
Ir buy'u�g on tontraa. Fee simple owners name
Retorders oifite where conVaU is recorded
Caunry
I( any
of the
• O t/
Tamship
Taing dialric� (city,
description I Is Ne
bW '�-3-I n cna.
Rewrd number � Page
❑ Mobila Homo (I.C. 6/.7-7)
of Ihe residenlial sWCNre or Me Wnd not esceeding ane (1) aae Ihat immediatety wrtounds that swcWre is used to protluce income, deuribe the use and portion
y uLlized to protlute irKOme.
� a�-/-�i'-D�-/GD -UQd. �S/-�o?aS �
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^" ..r� �' `� :�;STANDARD'OEDUCTION'qLLOV1IANCE,:y���'�""--,1`�.!�'�;.���+-"��-��,��:?3`i._;,..��',.,��v-�i.4`,3,���•-,x'"_e.:z:
c'b". • . J- ' P
20 _ Pay 20 _
Lesserof 1/2 Homestead
8
vaivanon a E35.000
SignaWreofAUdilw ' Datesigned