Homestead_CoyCLAIM FOR HOMESTEAD PROPERTYTAX
CREDIT/STANDARD DEDUCTION
Stete Form 5473 (R6 / 403)
Prasaibed by Ne Department of Local Govemment Financa
INSTRUCTIONS: See reverse side lor Rirrg ins6ucfions.
� �e) ' certi
I(VJe) occupied as our principal place ot residen Ihe following descnbed real prope or which a Homestead
❑ I(VJe) owned ❑ Are buying under contract
' Have a benefidal interest in the enlity ihat is liable for fhe property taxes on the property and that owns the C
If buying on conVact, Fee Simple ownefs name
Remrders olfice where conVaq is recorded
Counry
Tamship
�v •� -V�rawvv i
If any portion of Ne resitlenllal sWCtura w the
of the property utilized to produce intome.
��
FORM YEAR
HC10
fy Ihat or���istpa7�o�MqQUh, 20_
Property Tac Credit is ereDy daimed:
a wntract.
Record number � Pa9e
7sing district (riry, town, rownshiP)
97 j� the property in queslion:
� J� (/ ❑ Real pmperty ❑ Moblla Homo (I.C. 67.1-7)
ona (1) aae that immediatety sunounds Nat sWCture is used to produce income, describe Ihe use and portion
�— _ d� -/ 9-�9-�0� - oo�. �oo - o�� I
����a.�"xi2'��n��_3''.s^'�}'`��'�'u�Z'�':�'3�yi'��i.,"'i�1"-3STANDARD:DEDUCTION�ALCOWANCE 3�i.-?'�u`t�'3�-`��€ns,vta�'i�-'t�`,dLA'������`.a''qid:v`'��3
20_Pay20_
Lesser of 1l2 Homes;ead
ValueLOn w $35,OW S
Signature of Auditw � Date signed