Homestead_NetterCLAIM FOR HOMESTEAD PROPERTY TAX
. _- STANDARD/SUPPLEMENTAL DEDUCTION
State Form 5473 (R73 / 12-09)
� yw � PrespibeA by the Department of Local Govemment Finance
INSTRUCTIONS: See `everse slde /or fiLng insbuUions.
FORM
HC10
YEAR
�(yVe1 � � OJlOA certify that I(wej-o�e9�s�dry�CLt�V�^�P�
place of 2sidence or am (are) buying the following described real property for which a Homestead PropeAy Tax Standa�Q, QeQuctio9n is hereby daimed
er contraG on the date ihis applintion is filed, (date o1 filing). I(VJe): r��� �� y �[� ��
Own ❑ Am (are) buying under recorded conUact C��. M..�-T� _
Am (are) entitled to occupy as a tenanFStockholder of a cnoperative housing corporation v �-�\
❑ Have a henefidal interest in Me wst or the right to ocwpy the property under tha terms o( a qualified �@p1.�g�A��s�D OR
❑ Am (are) the shareholder, partner or member of the entity ihat owns the property.
(�eBal name)
of daimant'
Drivefs Ocense / Itlentifiration /
�
spouse (lasf frve d'gRs) Drivefs licerrse / Itlentifintion / ONe
of daimanCs spouse (last (rve diy7ils)
If buying rn conLact Fee Simple owneh rume
RetorAefs oRka where conttaG is recorded
Counry
Township
Tamg aisUict (dty, fawn,
Record number � Pape
Pa�cel number Legal tlesaiptbn Is Ne praparty in question:
� � Real {popesty � Mnuslh/ essesseA mob0e hortre (IC 61.7-
II arry portion of the residential sWCture w the land not exceeding one (1) aae Mat immedFatey surtountls Nat sw�re "s used m produce inoome. Cesaibe the use and poNm
W ihe propany uti�zed m produre 4�mme.
� � �-�a -i8" �a 3 - ao �. �"��-_ �j a�
Counry
Township
I hereby certify the above sfatements are We, cortect and complete.
ss (numDer end sheet. dty, stare. and LP code)
5 �.5 L. �•�,.
�
.- .
Land not exceeding t(orre) acre immedlatey
surtounAing resldenUal improvements.
Other lantl
Tofal land (Una 1 plus Iilre 1)
ResideMiallmprovementsorAnnualy ����ng
Assessed Mobile / Manufacened Home Garoge
Other Improvemenffi
Totel improvemenb (Iine 1 fhrough line 6j
7otsl value (line J pl� llne �
I hereby eertify the above is We, cortect,
and complete.
Jaitying adion - SigraLire of Autlitor
(z)
(3)
(4)
(5)
(6)
�)
County
S1.f y 'l L
20 _ pay 20 Lesser of 60% of the assessed value oi fhe homestead or $45,000
Nofrilhsferdlrg any otlrer provision, Ne wm d fhe deOUCfiwu provitled in IC 6/.7-72 fo e moWle home thel is $
not assessed es rael pmperty a to a menNactured homa Nat is not assessed as real pioperty may rrof exceed
ene-hatll/21 W fhe �.ro.�s,°a vefue o7fhB rtpW7e home or manWeCtured fame.
TamsNp
Date signed (monN.
Date si9rred (rtanth, day,
Date signetl