HomeMy WebLinkAboutHomestead_Smith (11)� CLAIM FOR HOMESTEAD PROPERTY TAX
���s CREDIT/STANDARD DEDUCTION
Sute Fwm 5473 (R6 / 1-03)
Prescribed by the Department of Local Govemment Finance
INSTRUCTlONS: See revcisc side 7or liling fnslrocfions.
FORM
HC10
�
YEAR
I M�e) lCXA1�Y� �� �j� Vi'4.�� �, certify that on tI��A� d¢j� 61 A��I} 2U—
I(We) occupied as our principal place of residence Ihe following desuibed real property for which a Homestead Property Tac Credit is hereby daimed:
❑ I (We) owned ❑ Ne buying under contract �� � � � ,
iif . � :
�' Have a benefidal interest in Ne entity ihat is liabte (or the properry taxes on the property and that owns the.property� Jis b�y� g�aTde� a OtraU.
If byvg on coniraq, Fee Simple owners nama
Recwdefs office where conLaq is
County
7amship
9' d L �U (.31Sf% � � �____.... .. � � ,
H any ponion of Ne residenilal sWCture w Ne WrM not a:cecding one (1) aae U
W Ne properry utilized to produce irrcome.
CovNy
- /�d -/O/- QD/. .3�G -
'-�-'��AhiF%r`�z�"�.�PROP.ERTY,OYVNED`;BY CL
Twvnship
I hereby certify the above statemenls are W e, correct and complete.
sheet c+N
Record numEer
e�sma (dry, mwn, row,unrP�
Page
�� Is Ue pmperty in que5tion:
❑ Real property ❑ Mobile Homo p.C. 6f.1-� .
wrtounds ihat swctura is used to produce income, desaihe the use and poNon
of
�
Twvnship
���`,-`-^�`a �'�:y,'�'��?�-�Yr`""-�v.-'�'+,� '"'R-�'< i�-` - -.. ,v�. � .. . . . . � . . .
i��'��iASSES50R�USEONLY.+"7��r�'��.:;��TRUETAX�4{� ASSESSED��V/LLUE �HOMESTEAD� � NON-RESIUENTIAL��?
a�:m� �. a'..�1t�:�y-ffr v.'...�^�"-'�t7'<�4r��,,,i e:aa�VALUEy r•,,y � AT 100% OFwTTV� �''sVALUE.�".�°,.-� ��sY��.d.�.b; VALUE ��p.�~�
Land not exceeding 1(one) acre immediately ",�k ""-�i�g ��s-lt��
_a ..
surrounding residentlal improvements. ��� g�-`����,,•'�i� �,�I��`.���;
Other land . �Z) }���� �.,. _
Tdal land (line 1 plus line 2) �3)
���1£ � v' �
�}�' J"r. �'^�S�l�� �
Dwelling (4) z�'�it�(*d- t.A�,,,���%��
Residentiel improvements or Mnuatly i���'� _��, �,
Assessed Mobila / Man�faQUred Hmre Gara e '�t -s-;•. ��
9 (5) ��`�� ...`�e '�'�����}
�:hi',;'�':��p;�?'
Other improvements (6) jaa��'5 �^�;n
.�t..t??�i�'�5r��
TUaI improvemenLs (line 4 fhrough line 6) ���
TUaI value (line 3 phs line n (g� .
I hereby certify the above is We, coved, and SynaNre otASSeswr Date signed
complete.
Verifyifxj action - Signature oflwdiWr Date s' ned
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