Homestead_BruceCLAIM FOR HOMESTEAD PROPERTY TAX
i, '. STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R7T / 6�09)
° � Prescnbed bY the DepartmeM ot Laml Goverturierrt Fnarce
INSTRUCTIONS: See leverse side lor fililg insfructions.
FORM YEAR
HC10
Y���
I(We) ceAify that I(we) om�pied as m`�'(ffdr) prindpal
place of residence am ( ) buying the foliowing described real property tor which a Homestead Pmperty Tax Standa��peduUio�n1is h�e,re1by �daimed
untler nVad on �he da[e �his a licalion is filed, ���)/A�-�
�,� pp (dateof��ing): GIBSON C ����N.A
IYT I(we) own ❑ Am (are) buyilg under reoorded wntract OUNiy q(�DITOR
❑ Am (are) entitled to occupy as a tenant-stockt�older ot a cooperetive housing coryoration
� Have a beneficial interest in the Wst or the right to occupy ihe property under the tertns of a qualified personal residence Wst
Te�g distrid (uty, town, townahip)
����.�
Rewd numCer � Page
.�
�arcel n/u�m6/e'r �% �e9ai Uesmptia/n� {� Is Ne poperry ui queslion:
�W � � �D l 1 � � • �� I `lJl U ❑ �� ProOeRY ❑ AnnuaM assessed modle home (fC 61.7-n
If any portim of Ne residential sWCWre or Ue W� not exceeding orre (1 j aae Ihat Immedialely wrtounds ihal shucN�a is used Io proEUCe inoome, tlescriGe Ihe use anC portion
ol Ihe properry uGlized to p�oGUCe inmme.
Counry
Tovmship
I hereby certify the above statements are We, cortecl and complete.
neeress (� �,ee ero �i, �: srere, em z�P �oeal r �
� /� / (.v
.• .
Land nol ezceeding 1(one) acre ImmeCiately
sunoundin residentialim rovements. ��)
Otherland (2)
Total land (line 1 plus line � (3) �
ResidentlallmprovementsorAnnualty �Iling (4)
Assessed Mobile I Manufactured Home Garage (5)
Other improvemerrts (6)
7otal improvemen� (line 4 Nmugn line � (7)
Total value (Ilne 3 pl�c line 7) (B)
I hereby certify the above is We, cortect, Signature ot/
and complete.
�M�9 airion - Sigrian�re of PL6tor
Counry
of tlaimant
20 pay 20 Lesser ot 60% of the assessed value of Ne homestead or $45,000
MoMiNSfaMUg eny ofherprovivon, Ne sun d the deCWions prmided in IC &1.7-72 b e moAde hwne Nat B
rot assessed as real property w(o a manWaclured hartie Nat a rrot assessed es real properly may rat a+ceed
rv�w.AnN /fnl Nfha w_vsr_ � vAlue e/ iha mobia homa ormanvtd�YU�ed hm�e.
S
TownSNp
Date signeC (rtronN. daY. Y��
Das signeE (rtronth. dzy.
SlgraWre o(�tor I Dete signe0