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CLAIM FOR HOMESTEAD PROPERTY TAX
,_ STANDARD/SUPPLEMENTALDEDUCTION
s�� wrm sa�a fRiz i sos�
�'` / Prescribetl by Ihe DeOartrtrenl ot Loml Gavemmerrt Fnance
INSTRUCTIONS: See leverse side lor fi!"ug inswctions.
FORM
HC10
YEAR
•
I(We) certify ( my our prindpal
place of residence or a re) buying the follo g described real properry for which a Homestead Pmperry Tax Standard Ded aion' reby daimed
under conirad on the date this appliptlon is filed, (date W filing): �U L� ���
❑ 1(We) awn ❑ Am (are) buying under recorded conVacl C� n�
❑ Am (are) enlitled to occupy as a tenant-stockholder of e cooperative housing corporation
� Have a benefidal interest in the Wst or the right to occupy the pmperty under ihe tertns of a qualified personal residence Wst �TOR
.• • •
Nartre of t( I name) �
Sodal Sequib nm6cr af (
_
Sodal Sewrity numbrr of Uaimant's spouse (lasf five dgrfs) Drivefs IiceM1Se / Identlfiration / ONer mim6er Issuing State
- of daimanfs spouse (lesl fire dgils)
� �•� �
H Wyvig om m�trscL Fce Simple owneYS �uma
Remrdefs o1Bce where contraG is recorde0 Record numbri Paqe
..�. . � . �
Counry Township Ta�g distrid (city. town. townshiy) �
P num r ��/��d 'p� IsNepiopertyinquestion:
" . - V ❑�I GroPert1' ❑ Annu2b/ 855�sM rtrobile home (IC Gf. f-7)
tt a�ry ponian W Ne resldenUal sWCwre or Ne IaM not exceed4ig me (1) aae that immedlateN s��� �t sWCWre o used to P�� inoort�e. Cesmbe the use and portion
ot �he P�oDenY utdaed to produ�s 4�come.
• � • � � : • •
CauMy Tovmship Counry Township
I hereby cerliy the above stetements are We, cortea and complete. �"a�re ( dai n �
Pddress (nurtt6er eM stree4 aN. �te, e� LPOOde)
� • . � • �
� � � i i . •
lantl not exceMing t (one) acre immediatey �,'T'w `��� � � � °� '�
aurrou�Min residential im rovements. (� � -s'��i: ��..+'$`s .+-���h
Other land (2) ��� �?,���+
Total land (line 1 plus line T) (3)
Dwelling (4) `'�����e-'�'���'���
Residerrtial Improvements orMnualty �.. sTU- a�.:,+� s ar�` .
Assessed Mobik / ManWacturetl Home Gare e �,`�`�'k"SF ��5` '` �Y`� �^:��'+,Y�=4�Y.
9 is) ..:.,}:,r?S,a!'��'��.�.'�x:�hY?`i»
�^..�`'rZr
Other Improveme� (6) ���'i}x::vf.-�„�;��r
7atal improvementa (llne / through line 6) (7)
Total value (Rne 3pl�aline n (B)
I hereby certify tha above is we, cortect, Sqnature otnssessor ' Date signed (mmrh, eay, yea�
and wmplete.
v�y�na acsm - S��an,re m a,cmr �� s�ud (momn. ear. r��
..... . . .
20 pay 20 _ Lesser of 60% ot Ne assessed value of Ne homes[ead or $45,000 �
No1wiL�stand"ag any aNerprovision, Ne sum o/ Ihe dedWiau pro�fed in IC fr1.7-f2 to B mobde lrome Nat a $
rot essessed as ieel propenyor lo a menu/actured Aorne Nat a not assested as real properry may mt exoaed
ona-ha%(1/JJ W Ne assessed velueW Ne mobile hartre ormanu/actured Awne. �
Sig�avrta ot N#rtw Date signed (rtronfh. daY• 3��