Homestead_StoneCLAIM FOR HOMESTEAD PROPERTY TAX �
" CREDIT/STANDARD DEDUCTION •
♦ � State Form 5473 (RS / 10-01) � � � ' - - ' � ' �
���� Presaibed by ihe Department ol Local Govemment Finance
INSTRUCTIONS: See 2verse side Ior �ling instn�ctions.
FORM
HC10
1(We) C/ ��CL(l(XiiZ C.�' ��lQ �/XJ7� /�{/ certify that on tMhe ist da�
I(We) oaupied as our principal place of residen e following�described real property for which a Homestead P perty Tac Cr it i
� I(We) owned ❑ Fve buying under conVacl
, Have a benefidal interest in lhe en' Uiat is liable for the m e taxes on the ro e and that owns the ro �"er�� �r+! i�,�
�h' P P rtY P P KY P P�Y or is buying
tl buying on conVact, Fee Simple owners name
Recordefs olfice where coniracl is recordeE
Record numEer
YEAR
20_
Page
Counry Tamshlp Tacing distriU (city, town, w hip)
Parce numher— t/� �/� W L I ��� V w u/ J�/ ��%�, Is ihe ProPeKY in queslion:
Real property ❑ Mobile Homo Q.Q 61J•� .
H eny portirn of 1he residentlal strucWre or Ne land not exceedirp one (1 � aae Nat immediatety wrtounds Ihat swcNre is usetl to praduce income, desaibe ihe use and portion
ot Ne property uUT¢ed to produce i�ome.
'- /QO - 00/,
-��,5
20_Pay20_
Lesser o( 7!2 Homestead
Vaivation or 56,000
S
signatureor�dd qAA /� I� /{�_p� Ioates" e�,�.
� v .r.ii vtiii �yo -o7-a3 �