Homestead_Kremer�} CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� Slate Fwm 5473 (R614-03)
Prescribed �y the Deparimenl of Local Govemment Financc
INSTRUCTIONS: See revcrsc sidc /orliling insfmcfions.
FORM YEAR
HC10
. 1 '..
� M�e) ` certify lhat on the 1st Hay o�Mar�U201
I(We) occupie as our principai place of residence the (ollowing descnbed real property for which a Homestead Properly.T�c Credit is hereby daimed:
/ �
❑ I(VJe) o ed ❑ Are buyirg under contract
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.�,��,J-y .� .�,
' Have a benefidat interest in ihe entity ihat is liable (or ihe property taxes on the property and ihat owns the property o� i� buying,under. a conVact�f: .
If buying om m�trad. Fee Simple owners name
Remrdefs ofice where conirad is recorded
Counry
Tamship
Tating dislrict (city, (own, townshiP)
Record number � Page
N3[�j���be� �O� ��I �eg��esSp 4gq ��O �_IO I Is Ihe Prope ❑ ReaPl propeRY ❑ Mobile Homo (I.C. 6f. f-n
%\/ N L�r i
If any poAirn of Ne residentlal aW cture or Ue land not exceeding one (1 � aae ihat immediatety wrrounds that swGUre is used b produce income, desttibe the use and porllon
of �he property utilized �o produce inW me.
• �L
�
S��-Qas
20 _ Pay 20 _
Lesser of 1l2 Homestead
veweLOn a 535.000
$
Signatura of Auditw ,�O w/1 (. �� I pl a Y F! � I �ate i n� ! I`