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3 CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� Slate Fwm 5473 (R6 / 403)
Prescribed by ihe Department of Local Govemment Finance
INS7RUCTIONS: See revcrsc side /or /iling inslrucfinns.
'; -' FORM % � � YEAR
HC10 �� �
Y � �..__' _ _ / �
FEB 2 7 2004
,�:-c.... ._ . ; . � ��"{,2�—�
��`^'e1 � nm � ( � ce7tity'tlial on'the tsl day of Ma�ch°. 20
I(We) occupied as our principa� place oi residence the following described real property for which a Homestead Property Tac Credil is hereby daimed:
❑ I(We) owned ❑!ve buying under wntracl
� Have a benefidal in[eresl in ihe enEty thal is liable (or the properry taxes on the property and that owns the property or is buying under a contraU.
I( buying om m�iraq, Fee Sunple owners name
olfice where conirad is rewrded
County
TamsND
Tating Et�IriEt filN, fown,
Rewrd number � Page
Parcel mber 1- !� �` Legal description Is ihe property in question:
�Q �— �� lY �./ �' w ❑ Real PropeM ❑ Nabile Homo (I C 6/./-n
H any ponion ot tl�e residential sWdure w the Wnd not exceeding ooe (1) aae that immediatey wnounds that sWCtura is used to produca income, descnbe Ne use and poNon
of the properry utilized to produce income.
`�P+ �� S � .�a- �� �. a �3�
��:'�.. �g��`��-r.ag_47a+�is.'?'.�'-�%'����P,ROPERTY;OWNED:BY'ClA1MANTdIN:OTFIER'COUNTIES����<'.`'.�,�-'_a�r3?{�,�.,3`.�k���y.�rS'E�
County Tawnship County Twvnship
I hereby certify Ihe above statemenls are W e, corted and complete. Signamre ot claimant
Address (numbe, and sheef, ciry, s�afe, ZIP code)
�
- "' t .'�.�^.. 'p��'g"�.1�'Yi� � "_r. y�a-e,�a- 3-s .....� .,y, 4. . .. , . . . � .«� Q, -.,
`� �r ASSFSSOR'USE ONLYr-� '' �'`�'� ° TRUE�SAX+{ t- ASSESSED�VALUE� � HOMESTEAD'�' `�iNON�tES�DENTIAL �ti
* ' " .�3.Ti=^5t4:�^;:itli4'�'.^i�.�,^T'��.n�%�.��r'. �-`�VALUE�e.,t`.'„'..� �AT.100%O�e.Tivt9 ��VALUEX',.�� �.'�SS��VALUE�-:��.��
Land not exceeding 7(one) acre immediatety �, �_ � �,�-v��wsyp
suvounding residentlal improvements. �� � � �� _. � ''���-��;�f,�i
Ofher land . �Z) x��``'T.r�''T°�-� .
-...,.��'�g'+�
Tdal land (line 7 plus line 2) (3)
� �;a,�.rF`z'�.�.._'`.�1� �' �y�-`�r#.1 "'-f�
Dwelling (4) ��r��{���F���r�R'�c ,��
Residendel improvemanLa or Mnually
Assessed Mobile I ManufacLUed Home Gara e ��y ,}� 3� ��� t/
9 `5) 6Y� A �Y��?��i�.�3'
ONer improvements (6) ��'��.� s`„ , '���
?:��g � " si.. S: ,��.
T�al improvements (line 4 through line 6) (��
T�tal value (Gne 3 pl�s line n (g�
I hereby certify the above is We, corred, and Signamre o�nssessor oate signed
complete.
Veri(ying actbn - Signature oflwtlitor Date signed
2��Pay 20 �)
Lesser of t/2 Homestead
va�uauon w E35.000
5
Date signed
—. ^ �,� ......