HomeMy WebLinkAboutHomestead_Lloyd, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
Siaie Form 5473 (R611-03�
Prescribed by Ihe Department ol Local Govemment Finance
INSTRUCTIONS: See revcrse side Ior /iling ins(mclions.
�a� FORM
HC10
YEAR
I(We) V� I\ `�— certiry �h�on th$1s�3yJot�yh,�Q�
I(We) as our principal place of sidence the following des ibed real prope or which a Homestead Property Tac Credit is hereby daimed:
(We) owned ❑ Ne buying under contract N 0 V 0 g�2004
Have a benefidal interest in lhe entity that is liable (or ihe property taxes on the property and ihat owns the projfity or is buyiqg upQ�r a wnt�aG.,
I( byvg an contrad, Fee Simpla owners name
Recordefs oifice where conVacl is remrded
Record number � Page
Counry Tannship Tacing di5lrict (ci to s�p �
um � � I�E�aI descriptbn Is ihe propert�yyin �question:
V �Q rcea� property ❑ Mobile Homo Q.C. 61.1-7)
If any poition af Ne residential sWCWra a the land not axceeding one (1) acre ihat immeEiatety sunounds that sWCture is used to produce inoome, describe the use and porlion
ot the property utilized tn produce income.
County
- /�-a?.� �.
Twrnship
hereby certify the above statements are We, correct and complete.
�Eress (numberaM sbeef, city, sfafe, ZlPCOde) ,� ,
Land nol exceeding 1(one) aae immediatety
surrounding residentlal improvemenls.
Olher Iand
Tdal land (line 1 plus line 2)
Dwelling
Residentiel improvements w Mnually
ASSessad Modla I Manufactured Home Garage
Other impravements
Tdal improvements (line 4 through line 6)
Tdal value (line 3 pl�s line n
I hereby certi(y fhe above is We, corred, and
complete.
� oa�.
r)
�2)
(3)
i4)
(5)
(6)
1�)
IeI
Signature of Assessor
Counly
Data signed
Date signed