Homestead_Gilpatrickr; CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
� � Sta�e Fwm 5473 (R6 / 403;
Prescdbed by the DeDartment of Local Governmem Fnanc:
INSTRUCTIONS: See revcrsc side !or lilinq insfrur,linus.
`nn 1 FORM
y,�, HC10
YEAR
��e) certi(y th9tVi1 ttte 7tt aa�7 March, 20_
I(We) occupied as our ncipal pla of residence the following described real pr erty for which a Homestead Property Tac Credit is hereby daimed:
❑ i(We) owned ❑ Ne buying under wntracl �f ,Q�
: Have a benefidal interest in ihe entiry Nat is liable for Ihe properry taxes on the property and that own��gg���� ptieR a contract.
IO
I( buying om m�tract, Fee Simple
office where wntracl is
Counry
Tawnsnip
If any porlion ol the residential sirucwre w iha Wnd not
of the property utilizetl ro produce inwme.
Counly
���
Twvnship
�) : --- - _ - -
� ' -
RerorO num0er Page
.. . • . � -.. .. -' �;:�:' . .
Taing tlislriti (city, fown,
!�U ��Real property ❑ Mobila Homo (I.C. 61J�7)
surrounds �hat sWCture is used b produce inwme. descfibe Ne use and portion
�c�gg osoa
= ��. /�S3 -
I hereby cer�ify the above statements are lrue, correct and complete. I`
/Wdress (nu beran streel, ciry, s(afe, ZlPcode)
`j )�)1 ��vGb�If� 71t• �-r. 6 Rrwe�{ � H71YP
y=��*�ok r'a"�ASSESSOR-0SEONLY �. ., TRUETA7f ASSESSEDVALUE �� HOMESTEAD -- � NON-RESIDENTIAL� �
;r.r�r� a� ... �-r _ � VALUE � AT 100 /e OF,TTV � . -' VALUE . ;:' VALUE �- - � _
Land not exceeding 1(one) aue immediatery - - -,.
surrounding residential improvements. (�� . . ' = �
Other land (p) - . .
Total land (line 7 plus line 2) (3) I
Dwellin9 (4) �. " s1:'�,-� � � .� :
Residential improvemants or Mnually ' .: ; `: ���. ; �. '' `: •.-'"".::-": . ;.• .
Assessed Mobile I ManulacNred Home � r�`
Garage (5) r�..;.. � .. ,__". -
Other improvements (6) (
Tdal improvements (line 4 fhrough line 6) (7�
Tctal value (line 3 phs line � (g)
I hereby ceAify �he above is true, cortect, and Signawre o( nsseswr Daie signed
complete.
Veri/ying acGon- SignaWre o/Audimr Date signed
20 Pay 20 _
Lesse� of 1/2 Homes;eac
vawaUOn or 535.000
'� -�.STANDARD.DEOUCTION
S
Datepynptl� ^
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