Homestead_Bezy���,�
CLAIM FOR HOMESTI �
__ STANDARD / SUPPLEI�
Sfata Fortn 5473 (R73 / 12-09)
� Presaibed by ihe DeparVnerR of Local Cwvemment Finarxe
IholRUC770N5: See reverse slde forfiGng ins6uUions.
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FORM
HC70
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1(We) %77 cerGfy that I p as y u pi
place of residence a am (arej b' q the fdbwin des � real prope i a Homestead Property Tax Sta��� i he c
urder contraC on ihe date this application is filed, (date ol filing). I(We): � JLJ
❑ Own ❑ Am (are) buying under reco�ded contract MAY 2 9 2012
� Am (are) entltled to occupy as a tenant-stockholder of a moperative housing corporalion �-�
❑ Have a beneficial inte2st in the trust or the right to ocwpy the property under Ihe tertns of a qualified personal resid"ehi� GL \' V
❑ Am (ere) the shareholder, partner or member ot the entity that owns ihe property.
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a.3L'Y.•<'lf.,fK}3�3Y +(� a.}i���� � 4�.._�5.�%.�.
}� � • Is Ihe perly in questian:
�,ti ZQ-� � 3 �Real property ❑ AnnuaDy essessed mo60e home (IC Sf.1-�
e(1) aae Nat immediatey surrountls that sW rture is used ro produce income, tlesaiba Ne use aM ponbn
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I hereby certify ihe above statemenis are We, cortect and complete.
PdOress (numba� aM sbeet, citl:
Lend not ezceeding 7(orre) acre Immediatey
surtounding resltlenUaf improvements.
Other lantl
Totel Iand (line f plus Ilne �
ResideMlallmprovemenfsorMnually �����9
Asaessed 61ob0e I Manufa�Nred Home Ga�9e
Other Improvemenffi
improvameMS (Ilne 1 Mrough line �
(3)
(4)
(5)
(6)
County
Toxnship
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