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"'" CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTAL DEDUCTION
S� ~ Sfata Fartn 5473 (R72 / 609)
° � Prewibetl by Ue Department of Lowl Govemment Frexe
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
YEAR
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I(We) � certify that I(we) accupied as my (our) prindpal
place of r i nce or am (are) buying the followin escribed real property for which a Homestead Property Tax Standard Deduaion is hereby daimed
untler mntred on the date ihis applicatlon is , (dafe o/filing):
❑ i(We) own (are) buying under recorded convact
❑ Am (are) entitled ro occupy as a tenant-stxkhoMer ot a cooperetive housing corporaGon
� Have a benefidal interest in the Wst or the right to occupy the pmperty under Ne terms of a qualified personal residence Wst
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Nameo/tlai n (bgalname)
soaai seaouv
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Sodal Se¢�riry numba
o1 daimam's sP�a (las! five dkJns) (��
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I( buying m mntrect, F¢e Simple wmefs rume �� ,/� _` _'
' �l/[J./\Li�.
•i.��Yi�iL.
ReooN re tract is remNeO� Record u Pape`/�
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3
�nry � Township ra�ri„g e�sba �dry: rowr�, rowr�nrp�
Pa�J n mber Le[g`a�l A/e'�scip' Is the pmperty in question:
�� � � O J L� ❑� P�D�Y ❑ AnnuaAY asses.aetl moWe home (IC &f. f-7)
Ii any portion W Ifre resitlential struWnne n Ihe IaM nol exceed'uig rne (1) afxe that immeEiatety surtauntls ihat etruccura is used to pm0um i�ne. Oescnbe Ue use aM portbn
or the woveM w9zee to vroeuce incoma. �
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Counry Town:hip Caunry TawnsNp
I hereby cetlify fhe above ststements are We, corteG and complete. Signat re ot da" �
Pddress(n 6erantlsfree4dN. ,aMZlPcade)
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Land not ezceeding 1(one) acre Immetliately � �q`i�;�y, �, p���{°t"��`;� ���.
surtoundin resldentialim rorunens. � 1 �{� a:..,?;,-��:s;`�y.�,.,.-�w�_'`��c��
P :�J y�i Y�. . .
Other IanA (2) ' ���-� ^�.�
To41 land (line 1 plus line Y) (3)
ResldenUalimprovementsorMnualiy ��ling (4) � ���'��-�`�,�E.�,�.°yr��"'��'�?+'��,�'y'�'i-'�
Pss�sed Mobib I Manufactured Hortre � a� ��� t""� -
Garage (5) � �E.'��r,.z: -u�:�"i: �„
�_,-�� p�.c=a.a.
Other improvements ' (6) �'y�����:,����
7oql improvements (line I througA line 6) (7)
Total value (Ilne J pl(s line 7) � (8)
I hereby certity the above is We, cortect, Sigriawfa af Assessor Date signad (rtronfi, day, year)
and wmplete.
Vaityi� actlm - SignaWre of Audtor Date signe0 (mrnN, day, yea�
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20 pay 20 Lesser ot 60% of the assessed vaiue o� the homestead or 545,000
NohvifhSfaMing eny other plovision, Ne sum o/ lhe deducflons providetl in IC 6-7.7-f2 ro e mobi7e home Nat @ $
not essessed es real property w fo a menufactured hwne Nat is not essessetl as real properry mey not exceed
mN�atl (72f d Na assessed vs/ue d Ne mobi/a hame wmanuFdctured hdne.
Signauue d Audtta Dete signed (Qronfh. daY. �
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