Homestead_GogelCLAIM FOR HOMESTEAD PROPERTY TAX
- ' CREDIT/STANDARD DEDUCTION
\ � State Form 5473 (RS / 10-01)
•� Prescribed by �he Depar4nenl of Lacat Govemmenl F"uiance
INS7RUCTIONS: See reverse side lor �ling insfructions.
FORM
HC10
�
YEAR
r MAi (i %�
I(We �� certiy that on'tHe 1st Ua� oTTTa�rch, 20
I(We) occupied as ou rincipal place of residence the follmving described real propert r which a Homestead P rty T�c Cr it is hereby daimeG:
❑ I(We) owned ❑!ve buying under contract �/�/ �
. Have a benefidal interest in the entity that is liable for the property tarzes on the property and that owns Ne pmpe�y,oiis�uyingTunder a�ntraG.
If buying on contraq. Fae Simple owners name
-
Remrdefs ofim where mntrad is recorded
Caunty
��Y �o,Ue� f
of the property uLTaeO in
a�-
� I Legal descripGon
i w Ne IanE not axceedinp ona (1) aae Nat
ie.
_ /QO - �o�. a/r- Q�
�'�?�' iPROPERTYiOYJNED;BY
Twvnship
I hereby certify the above statements are We, corted and complele.
Address (number aM sheet, dy, atate, 21P code)
\�P � R�,,..i�l•�_2n_�L R.,.._.,L ^.
Land not exceeding 1(one) acre immediatety
surroundina residential imorovements.
Other land
Tdal land (line 1 plus line 2)
Dwelling
Residendal imprwements
Garege
Other improvements
TUaI improvemenLs (line 4 through line 6)
Tdal value (tine 3 pl�s line n
I hereby certify the above is We, corted, and
complete.
Verifying adion - Signature af Autlitor
(�)
iz)
(3)
(4)
(5)
(6)
(�)
(8)
SignaNre of Assessor
�
Record number Page
I Is the property in pueslion:
f�•rrw �oo�y ❑ Mobile Homo (I.C. 6 f. f-�
wrrountls ihat swcwre is used N praduca income, describe Ihe use antl portion
7
ot
Date signed
Date sgned
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