Homestead_MercerR, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R6 / 403)
Prescribed by Ne Department of Local Gavemment Finance
INSTRUCTIONS: See reverse side /oi liling mstruclions.
FORM
HC10
YEAR
��e) � 'fy that on the 1 st day o( March, 20
I(VJe) o ed as our principal place of residence lhe fol wing described real property for which a Homestead Property Tae Credit is hereby daimed:
I(We) owned ❑ Fve buyirg under contract � y{ 'j� yT-� �
� p �
Have a benefidal interesl in the entity that is liable for the propeAy taxes on the property and that owns the prope or is bfiNn� er�nVact.
I( buying on conVaq. Fee Simple ownefs name
ofice where conVact is recorCed
�n� — U / / Tamship Tating tlis � ( �ty, townshiP)
r- i
m /� Legal description Is ihe property in question:
V � Real property ❑ Mobile Homo (/.G. 6f.1-n
N any ponion o( Ne residential sW cture w the land not e:ceeding one (1) aae Ihat immediatey wrtounds Ihat swaure is used lo produce income, desvibe the use and portbn
ot ihe properry uWized N produce income.
viv.��izs�
Counry
I hereby certify the above statemenls are W e, coned and complete.
ddress(num6uarMsUeef,ciry,.;(ate,ZlPcnde) _
Land not exceeding 1(one) aae immediatety
surrounding residential improvements.
Other land
TUaI land (line 7 plus line 2)
Dwelling
Residen6al improvemenCS or Mnualy
� �� / �^��� H� Garage
Oiher impravements
Total improvements (line 4 through line 6)
Tctal value (line 3 pl's line n
I hereby certify the above is We, correct, and
complete.
Vaitying actio� - Sig�ture of Auditor
20 _ Pay 20
Lesser of 1/2 Homestead
vauauon w 535.000
SynaWre of Audita
(�)
1z)
(3)
(4)
(5)
(6)
(�)
IB)
Signature of Asseswr
County
5
- oas
signed
signed
��° 02 0 - c�