HomeMy WebLinkAboutHomestead_TooleyCLAIM FOR HOMESTEAD PROPERTY TAX
_- STANDARD/SUPPLEMENTALDEDUCTION
Spte Fam 5473 (R13 / 12-09)
`,•w Presai6ed by Na DepaMient of Loral Govemment Finanm
INSTRUCTYONS: See 2verse slde for filina insbuc0ons.
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FORM
HC10
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I(We1 certi t I pi r) prindpal
place ot residence or am (are) buyirg ihe fullowing descri real property for which a Homestead PropeAy Tax Standard Deduction is hereby daimed
u r mntraG on ihe date this applintion is filed, (date o7filing). I(We): O CT 1 Z� �Z
Own ❑ Am (are) buyirg under recorded contract
Am (are) enGOed to occupy as a tenant-stockholder of a cooperalive housing corporation
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❑ Have a 6eneficial interest in Ne wst or the right to occupy the property under ihe tertns of e qualifiedpe rsonal residen � •
❑ Am (are) lhe shareholder, partner or member of Ne enGry ihat owns the property. U'BSON COUNTY AUDITOR
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Name ot dalmant (legal ^ame)
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$adel ° '
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Name W daimanYs spouse (kgallame)
SoUal Sewriry numhar ot tlamanCs spouse (last five dgks) Dmrers 6certsa / Itlentlfiniion / Other numDer IssWrg State
of tlaimant's spouse (last (+ve digiLS)
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If buy'ug on tontraG. Fee Simple ovmefs name
Recordefs office where oontred is recorded Reoord nwnbu Page
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Counry � � TownshiP T (c#�:lown
Parcel number Legal desulption Is the in question:
Real prOperty MnuaOy essessed moh�e home (IC &1.7-7)
IF arry o Ne resitlential structure w the IarM nat exceedin8 one (1) aae Nat immediatey wrrou that swuure is used W produce income, desaibe 1he use aM portbn
of ttia to proCUCe Ncome.
o� _�/-3a-3�3 _��� �90 .�a�
... . . : . .
Counry Township Counry Township
I hereby cer�fy the above statements are true, cortect and complete. Signawra of davnant
ress (numDe� end sneet, dry, stare, end z�a coee)
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Land not exeeeding t(orre) acre immedlatey 1 ��r '``+F s"3 '' ..,,' '`�
surtoundin rasldentiallm rovements. � ) ��':�-- �Y �j'.
i! cs'+r ='°
Otherland (2) %�_'P_ ' �?"_
Total land (line 1 plus ll+re 1) (3)
ResideMial imprpvemenls or Mnually �BIIIn9 (4) `� �� ;,�G1,,,�"�-�;+-�.�"`�r�s��Y
AtSessed Mobtle I ManufxtuRd Home � 4,� r-r. x�.-. .�, .:,}.�.��r �#_.
Garag° �5) � ..,. t,.�-.�`�a�?�:.�.�„r:
Other Improvements (F) � #s��+"��' � � � � �
Total improvameMS (lirre I through line � (7)
Total value (Ilrre 3 pl�a flne 7) (8)
1 here6y certity the above is true, correct, �e^a�+�e of Assessor Date sig�tl (monN, dey, yeaA
and eomplete.
Vei�Y�9 eWon - Signature oflWdilor Date si9ned (rtanN. daY• Yee�
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20 _ pay 20 _ Lesser of 60Wo of the essessed velue of the homestead or $45,000
Nohvi7listeMLg anyofherprovisbn. Ne sumWfhe deductions yovidetl in IC G7.7-12 fo e rrobile home Nef is $
nof assessed es real property w fa e menNactuied frorrie Nat is not essassed es real propany mey mt axceed
mahatl iR) W Ne essassed vehreW Ure moW7e hane wmenWaUUrad home. �
SignaWre af PLEitn Date signed (monfh� daY.1'��)
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