HomeMy WebLinkAboutHomestead_Cummins (4)CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
Siate Fortn 5473 (R13 / 12-09)
` Prescribed by the Departmeitt of Local Govemment Finance
INSTRUCTIONS: See reverse strle for filing inshucNons.
FORM
HC10
YEAR
��e� certify that I(we) ocxupied as my (our) principal
place of reside or am (are) buying the following described real property for which a Homestead Property Tax Standard �pQi��c� � h��r daimed
under contract on the date this application is filed, _� (date of filing). I(V11e):
C . � . IY�.�x���
�] Own [] Am (are) buying under recorded contract
�� Am (are) entiUed to occupy as a tenant-stockholder of a cooperative housing corporation GIBS.�N CC�U�TY AU�I. 9�
❑ Have a beneficial interest in the Vust or the right to occupy the property under the terms of a qualified personal resi ence ru �
❑ Am (are) the shareholder, partner or member of the entity ihat owns the property.
Neme oi
Name
�� � ' �) �river's license /
name)
Security number of daimant's spouse (last five dJglts) Drive�s license / IdentiHcation / Other number
of daimanYs spouse (last five dfgits)
If buying on contract, Fee Simple owners name
Recorders ofGce where conVact is recorded
r.
Parcel number �egai answ�puun
,�.s-�- oo-o . � -�a
I any poRion of the residentlal structure or the land not exceeding one (1) acre that immediafely
oi the property utilized to produce Income.
County
Township
i hereby certify the above statements are true, correct and complete•
�d J`f h lrands� �� � D/� e�'�/{�P e) K/!l
!1 l/ � i" � �^ S �V �I �
Land not exceeding 1_ (one) acre immediately
Other land
Total land (Ifne 1 plus Ilne �
Dwelling
Resideptia{ improvements or Annually
Assessed Mobile / Manufactured Home Garage
Other improvements
7pta1 improvemerrts (line 4 through line 6�
Total value (Iine 3 p/us line �
1 hereby ce�tify the above is true, correct,
and complete.
Veri(ying acUon - Signature of Auditor
(1)
i2)
(3)
(4)
(5)
(6)
�7)
�8)
Signature of Assessor
district (cit}, town, township)
County
IssWng
Record number � pe9e
�th,--e;� perly in question:
eal properry � Annually assessed mobfle home (IC &1.1-n
ds hat struclure is used to prpduce income, describe the use and portio�
�
2p pay 20 Lesser of 60°� of the assessed value of the homestead or $45,000 I
a
Township
Date signed (month, day, yea�
Date signed (month, day, yea�j