Homestead_Hurst (12)CLAIM FOR HOMESTEAD PROPERTY TAX
. __ STANDARD / SUPPLEMENTAL DEDUCTION
State Fam 5073 (R73 / 12-09)
� y� I Prescribed by Ihe oepartment or Local Govemmem Finance
INSTRUCTfONS: See ieverse slde lar filirg instructions.
�a��3
FORM
HC10
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- -1 (We1 v fTl � CI1 � � ]d` L� V 0 � e : " " `�., certifY that I (we) ocwP��d4s m1cIHY1/ �^^p�
place of residence or am (are) uying the following described real property for which a Homestead Property Tax Standard �eQ�ction is hereby daimed
�er contract on ihe date lhis appliration is filed, (date of filing). I(VJe):
Own ❑ Am (are) buying under recorded contrsct pIBBON COUNTY AUDITOR
Am (are) entitled to occupy as a lenant-stockholder of a moperalive housing corporation
❑ Have a beneficial interest in Me Wst or ihe right to ocwpy the property under ihe tertns of a qualified personal residence trust .
❑ Am (are) ihe shareholder, pariner or member of Ne enfiry that owns ihe proparty.
Name d
Name of
spou,e (last
s��a,;�E .'F'"°.t�:_.:>a ' *,.r.c�?' u1'3.;.v.v�';
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Drivefs Gcrnse / Itlentlficel
of daimant (lacl five digits)
ot da4nanYs spouse (last �ive dlgits)
Parcel number Legal tlesmption
�r.-, - t�--\g - ,�.t� l - b�F .33h -ta�g
It a�ry ponion ol the residenGal sWCture w ihe IarW no[ exceeding one (t ) ave
Of Ih0 �fOp8fl1' UCII22d b yotllNB UICOTC.
�
Counry
Tovmship
I hereby certiy Ne above sfatements are We, correct and complete.
sbee4 �1: �ate, aM ZlP oode)
Land not e:ceeaing 1(orrel acre
Other land
Tota1 land (lirre 1 plus lilre 3)
ResideMial improven
Assessed Mobtle/Ma
Other Improvemenb
(�)
�Z�
(3j
orMnually �BIIIn9 (4)
4�md Home ��ge (5�
7ots1 improwmeMS (Ilna I Nrough (ine �
Total value (llne 3 plls lina n
I hereby certity the above is We, correct,
and wmplete.
Veih�ng adian - Sig�ture of iWditnr
Counry
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3 }+. �a SiF
�*-w 1�.c ' �cS r I %iiv � � 5 F;. �'- � '���^-'d*�'e ��i�
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;�COUNTIFS, �t' °:'tYi"x e✓'.'�'' ., _.y.3n
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Signature af Assessor
20 _ pay 20 Lesser of 60% of the assessed value oi Ne homestead or $45,000
NohvilhstandNg any afher provision, Ne sum ol Me deductiwrs provNed In IC 61.7-12 fo e rraWle Mrne tl'at a
not ascassetl es rael property w fo e menNaGUred home fAef is not essessad as 2a1 property may not exceed
s�m�
$
Date si9ne4 (monlh. daY Y��i
DaOe signeA (month. daY. Yaa/)
��rn, a
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