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" CLAIM FOR HOMESTEAD PROPERTY TAX
!° ._�,• � STANDARD / SUPPLEMENTAL DEDUCTION
State Porm 5473 (R72 / 6-09)
,S = Presrribed hy tha Department of Local Gwemment Fna�xe
INSTRUCTIONS: See raverse side for filing insbuctions.
1 \ `� .
FORM YEAR �
HC10
IL
I(We) certiiy ihat I(we) occupied as my (our) prindpal
place of residence or am (are) buying ihe following de ' ed real property for which a Homestead Property Tax Standa�edudion is hereby daimed
under mnVact on ihe dale lhis application is filed, (date of filing): � t
❑ I(We) own ❑ Am (are) buying under recorded coniract �co NTY AUD�T�R
❑ Am (are) en60ed ro occupy as a tenant-stockholder of a cooperative housing wrporation G�BS�N
� Have a benefidal interest in ihe wst or the right to occupy the property under the terms of a qualified personal residence wst
Name
Sodal Senrtiry numbes of qaimanYs spouse (Wst frve
If buying on contrac4 Fee Simple ovmeYS reme
Remrdefs office where mntrad is recaNeC
Caunry iownsl
Dr'rvefs lirense I Identifitation /
ol da"unant (bst Irve d'giLS)
Issuing State
ol daimant's spouse (las! frve dgiLS)
a� -��'� =°�0���3. n �-����"w� ��
�It any portbn of Ne msidenllal SWCNre w Ne la� not e*rceding orre (1)
of Ne propeny uN¢ed m proCUre income.
Courrty
Township
I hereby certity the above stetements are We, cortecl and complete.
Land not exceeding 1(one) acre immediatety
Olherlantl
Total land (line 1 plus line 4)
Dwelling
Residential improvements or Annualty
Auessatl Mobite 1 Manufactured Home Garage
Olher improvements
Total Improvements (llne I NrougA line 6j _
Total value (line 3 pl�a Ilne �
1 hereby certify the above is true, cortect,
vaifying action - signaa�re or Auditw
(2)
(3)
(<)
(5)
(6)
�)
(8)
Sgnacure of Assessor
Retwd number
Tarirg disiria (rity, rown,
Page
Isihe em'inWeSiion:
Real praperty ❑ AnnuaP/ assested rtqdle home (IC &1.1-7�
unds �hat swcWre is useC m produce income, desrnhe Ne use aM portion
tlaimant
20 _ pay 20 _ Lesser of 60% of the assessed vaiue of �he homestead or $45,000
NolwilhslaMing any otM1erpmvivon, the sum o/ the deductions pro�nded in IC 6-1.1-12 ro a rtm0�1e home Nat is g
riW assassed as raal propeM or �o a menulactured hwne thef k nat essessed es real pmperty may rwt exceed _
ev�ahntl /1rz1 d fhe ascassed value of Ne mobtie hama w manWaUU2d horrie. ._ _
Towr�ldp
Oate signeE (monfh, day,
ear. s�d
5igneE (monN. tlaY YEa�
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