HomeMy WebLinkAboutHomestead_HoeflingCLAIM FOR HOMESTEAD PROPERTY TAX
__ t STANDARD / SUPPLEMENTAL DEDUCTION
Slate Fwm 5473 (R73 / 12-09)
` / Presaibed by the Department of Locel Gwemment Finaxe
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lNSTRUCTfONS: See reverse side !or filing insfi�Uions.
FORM
HC10
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I(We) �C-% L U f // � certiy �hat I(we) ocapied as my (our) prindpal
place of residence w am (are) buyirg the fo wing desmbed real property fw which a Homestead Properry Taz 'o�ereb� imed
er mntract on ihe date this applintion is filed, (date o/filing). I(We):
Own ❑ Am (are) huying under recorded contrect
� Am (are) entilled to ocwpy as a tenant-stockholder of a cooperative housing corporation r��� n�012
❑ Have a 6enefidal interest in Ne wst or the right to axupy the property under ihe tertns of e qualified personal reSi uas .
❑ Am (are) the shareholder, partner or member of the entiry that owns the property. C ��.�_
ji�],(TL-�
s� sma�H �un,ee�
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Nama W daimants spouse (le9al name)
Sodal Seairiry num6er ot tla'unanYs spouse (las
It byvg an contract, Fee Simple avnets name
Remrdefs ofGce Wwe contretl ¢ recorded
Counry
Patcel number
Township
omars u�se i iaenuece�
01 daimant (lesi frve digifsf
ot daimant's spouse (Wstlrve dg�E)
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- `�
- . .' '
�y; ��'.��'x�-:t` sr s 4 _: :,:�
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l�rF.,.; .: �?vY„�d, � y�i'r._. �.. f t�:.�.+?i.�. �.�
f • ��
I I.� �' �"Y LJ �+��r �ea mome n� ��c �v i-n
It arry portion ol tha residenlial structure w the Imid not exceeding one (1) aae that immed'ateJy surtaunds ttiat sWtlure 6 used m produce income. Oesaibe ihe use and portion
W tha P�oPertY uti�reA to P��� �rtre.
�?G- o�o?�,�a�aoo. �Gd_a�o
Counry
I here6y certfy ihe a6ove statements are We, correcl and complete.
(nUm6ef BnO streef, df}; SfefB, eM
Land not axceeding 1
Other lantl
�
acreTmmedlatey I (�)
m� k
roml land (line r plus �tne T)
Dweiiing
Residerrtial Improvemenls or Mnua�y
Asseased MoAtle / Manufacwred Hortre Garege
Other Improvaments
Totel improveme�rts (firre / fhrough line �
romi vai�e (llne J plla Ilne 7)
I herehy certify the ahove is We, corteet,
and eomplete.
Veifying aWon - Sigreture Mlwditnr
�2)
(3)
(4)
(5)
(6)
�)
ie)
or,assessor
Counry
of tlaimant
20 _ pay 2(1 Lesser of 60% of the essessed value of the homestead or &15,000
NofwiMSfending eny oNer provision, fhe sum of Ne deductions pmvxletl in IC 6/.7-f 2 ro e nobile home that is $
not a.ssessed es real property a ro a men1dactwed hana Nat is not essessed as real property mey not exceW
one-hau (t21 W Rre assessed vaNe W Me mobae hort�e wmanedacrured Aome.
Signa¢ue o(PLAitw
Tavnship
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�r. r�n
Y�
(month. daY• 1��