Homestead_Wilkerson (17)CLAIM FOR HOMESTEAD PROPERTY TAX
.__ STANDARD/SUPPLEMENTAL DEDUCTION
' State form 5473 (R73 / 12-09)
� yw ! p�ajp� yy � p¢pa��t of Local Govemmenf Finarce
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INSTRUCTIONS: See reverSe sfde (or filing inst�uclions.
FORM YEAR
HC10
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I(We) ���M�. �� 7���..l�.�idi1 ceAify that �� u�.upi�my (our) prindpal
place o( resid ce w am (are) buyirg the follovring described real properry fa which a Homestead Property Tax Shandard Ded3y��i�•n—'i�s hereby daimed
urder d on the date this application is filed, (date o1 filing). I(We): C�����'� v V
Own ❑ Am (are) buying under recorded conlreIX �pUNTY AUDIT�R
❑ Am (are) entltled to occupy as a tenenbstockholder of a cooperetive housing corporation GIBSON
❑ Have e benefidal interest in the Wst or ihe right to ocwpy the property under the tertns of a qualified personal residence Wst .
❑ Am (are) Ne shareholder, partner or member of ihe entity �hat owns ihe property. � -
Narre o( tlalmant (legal ^eme)
Name ol daUnanCs spaisa
ur aam,anra spase (fast rrie
If buying on convart, Fee Simple ownets nama
County
Counry
oRCe where conhaC is tecorded
Towiship
Dtive/s license I Itlentlflfatbn
of daimant (les! five digttsJ
or aahnanrs spa,se (�asr rrve elgrts)
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_
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-.�:�hh� _}YiY��J �Ln{'lJ:'fGi :�4�.L$"..4is�, S'-�:>
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%�+.X.;�� �41�.�Yii�}�y 1� �'lJl 1 '/s �. �L S—?'
IS �h8 PIOPBfIY III QUCSIIDfI:
❑ r�i �nY ❑ rw��ny �essea monua nw,� oc 6�.,-n
of Me residentlal structure or Ne tarW nat exceeding me (1) afre that Immetliatey w�rounds Ihat sWUwe is used b P�um'vxome, desaibe the use antl
y utifaed m protluce Inoome.
SS C�Sy
1 hereby certiry the above statemenLS are We, corred and complete.
Address (number and sheet, tiry, sfafe, aM ZIP coda)
not axceeding 1(orre) acre Immedlatety
Other land
rotel land (line f pfus rlrre 3)
Reside�rtial improvements or Annually
l�sseased MoEOe I ManufxTUred Home
Other Improvements
�
(3)
DweII1nB (4)
Garage
Total imp�ovamerKS (llne 1 Nrough line 6)
Total value (line 3 pl/a Une 7)
I hereby certify the above Is Wa, correet,
and eomplete.
veritying edlon - signaWre orNMimr
(5)
(6)
m
�8)
SIg�Oire of Assessar
counry
of
20 _ pay 20 _ Lesser of 60% of the essessed velue of the homestead or $45,000
NoM+lhSfentling any otherprovisbn. Ne svm of Ne deductbns provided in IC &1.1-12 fo a mobde hwne fhaf is
rat essesseO as real property w fo e manu7acturad fame Net is raf assessed es reel property mey rro( exceed
ene-hatl /121 o7the essessed velue o/ the rtrobile hortre ormanWactured Irome.
(monfh, deY• Y��1
aay, yea�
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