HomeMy WebLinkAboutHomestead_Grubb"'" CLAIM FOR HOMESTEAD PROPERTY TAX
;�._,. = STANDARD I SUPPLEMENTAL DEDUCTION
Stata Fartn 5473 (R72 / 609j
�O ,��� 2 Prescribed by the Department of Local Govemment Friance
�NSTRUCTIONS: See reversa side for filirg instrucfions.
��
FORM
HC10
YEAR
/U / �
1(VJe) cerlify ihat I(we) occupied as my (ourj pri�pai
place of residence or am (are) buying Ihe foli ng described real proper�y for which a Homestead Properry Tax Standard Dedudion is hereby daimed
under conVact on the date lhis appliqGon is fi ed, (date ol filing):
�I (We) own ❑ Am (are) buying under recorded contrect
❑ Am (are) entitled [o occupy as a tenant-stockholder of a cooperalive housing corporation
� Have a benefidal interest in �he Wst or the nght [o occupy the pmperty under Ihe terms of a qualifed personal residence Wst
dig3s) I otrvers frense /
�
(legal name)
Sotlal Securiry numCer of dalmanCs spouse Q2st �ive dgBS) I DrrveYS license / ItlenGfication / Oltie
ol daimani's spouse (Wsl (rve dyits)
11 buying on conbact, Fee Simple wmeYS rtame
mnvea is e�mded
Township
V � p,S 0 /1 r
Parcel number �e9a� �
V. .p7• 0! K
If any port»n ot ihe residenfial sWCW re a ihe land i
of Ne property u0T¢eE to P�uce inmme.
Caunry
Township
I hereby certify the above statements are we, correct and complete.
AOCress
Land
ciry, stare, arwl
acrc immediauty
Otherland
Tofal land (line 1 plus line �
Residentlal improvements ot Annualty �elling
l�ssessed Mobile 1 Manufactured Home Garege
Other improvements
Total improvemenb (Ilne 0 NrougAline �
Total vatue (Ilne 3 pl(s flne 7)
I 1 hereby certity the above is true, cortect,
and complete.
Vailyut9 aCtion - SigriaW re of AuditDr
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(2) (
(3) j
�4)
�5) ��
(6)
(B)
Im"u�g State
Recard numCer � Page
OistriG (ciry, town, township)
Is Ne property in question:
����/y �Real property ❑ Annua%essnsud mohile home (IC Gf. f-n
ihat immediatety surtountls Ihal sWClure is used m pmduce income, desaibe �he use aM pwtion
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ITownshiD
e of tlaiman� � '
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ifl
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� ��V?� � `Y��`s« �-T
%Q� �._:.;r.,._ ..t.�_.
t.--�..�.�`�' � C� _
� �. x,fn
700 5700 �,,+��
; yl."v',�,�s ��,�
?Sa.^3' CV.3. i 'iF. �l�.
it4-�Sl�K Yry S�[•MC� f ..
�900 �o9b o :�,�-,..�a,,��e�.��
O J t_� �
F�i`n ���� �1;�
900 o9eb
�eDO oo �
Da:e ' ed (monN. CaY. YPaA
r.o..Q,�- � y o g
Da signed (rtronlh. daY. 3'�a�
20 _ pay 20 _ Lesser of 60°h of the assessed value of the homestead or $45,000
AblwithsfaMing eny WAerprovisiori, Ne sum a( the tletluctions providetl 1n IC 6f. f-12 ro a mo6de home Nat is
mt assessed as ieal property wW a manufactured home Ne1Is nol assessed es ieal proparty mey rm1 excead
nnMwM/flll NMa acsacsed vdlue d Ne mobde M1omE W manulaUUBd fart�e.
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