Homestead_Simpson (7)n.
, CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
/ Sla�e Fwm 5473 (R6 / 1-03)
Prescribed by the Department of Locat Govemment Finance
INSTRUCTIONS: See reverse side Ior /ilinq insfruclions
1y\ � FORM
� � HC10
YEAR
__, ']:1��...'.i
� M�e) �al'onftli�TsTday of March. 20_
I(We) occupied as our principal piace of residence the ( o'ng descnbed real pr eAy for which a Homeste�r� T�qC rt is here���ed:
❑ I(We) owned ❑!ve buying under contract ��l � G{yyp� �punty
, Have a benefidal interest in the entlty that is liable for �he pmperty taxes on the pmperty and Ihal owns the o�erty or is buying under a wntraU.
Parcef
1( 6uying on conUacl, Fee Simple owners name
Recordels otfice where conLad is recorded
,-.'-•._-;.�a-`.'--�'..2.�'����' � te<=1c:;:"��", _ � �yri
. n�.?`[2.S-c� .h.. a .
Counry ramship
Legal
�r i -c��� r�f.c� i
rc any portion ot ihe resiaential swcture w the
ot tha properry uWized b produce income.
exceeding one (1) aae that
Rewrd num6er � Page
Tacing Eislrict (riry, fown, fownship)
Is the properry in question:
' ❑ Real property ❑ MoWa Homo (I.C. bf.1-�
�unds that sWGUre is used to produce income, desuiba Ne use and portion
i �� - �y i�-ioa - c�i y�c -oa.s i