Homestead_Brown (2)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
` State Forth 5473 (R817 -07)
I
Prescribed by the Department of Loot Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
I (We) .� � 1.Y�� ��y LXli�� r'— certify that on the 1st day of March, N)_
I (We) oaupied as our principal place of residence the following described real property for which a Homestead Prepe4R4; C&4 i j W8by claimed:
❑ I (We) owned ❑ Are buying under contract d'
®Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property of wwyiw"Kd r a contract-
CONTRACT RECORDED
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
Tamship
rcel number
b -17 -� 4QD�oD•
Legal description
foal
Is the property in q n:
(J jyrQ V-<-] property
Mobile Home IC 1.1 -7)
If any portion of the residential structure w the
of the property utilized to produce income.
land not exceeding
i
I
7.e (1) acre that imrye�'ia y ounds (hat structure is used to produce income, describe the use and portion
1
PROPERTY OWNED B
TRUE TAX VALUE
County Township
County Township
I hereby certify the above statements are We, correct and complete.
Si azure claimant
_j.- dress (number and sheet city, slate, and ZIP crode '
G r�'70 rs c�u�P.�sai /l — GGs
NVA
ASSESSOR USE ONLY
TRUE TAX VALUE
'
NON-RESIDENTIAL
$
of 43,000 for 2009 pay 2010 40,000 payable after 2012
AT 100% bF TTV
VALUE
"VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
I
Total land (line 1 plus line 2)
(3)
Dwelling
(4)�"
_
Residental improvements or Annually
-
Assessed Mobile I Manufactured Home
Garage
(6)
Other improvements
(6)
.
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus fine 7)
(8)
1 hereby certify the above is true, correct, and
Signature ofAssessw
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
__________ \1 __________`_____ ________ �____________________________________________________.--.---_________-_ .___________--- ________________
pay 20 _ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of ill 44,000 for 2008 pay 2009 41,000 for 2011
Homestead Valuation pay 2012
$
of 43,000 for 2009 pay 2010 40,000 payable after 2012
nor
f)ats(siyraed month, dayYea,
__________ \1 __________`_____ ________ �____________________________________________________.--.---_________-_ .___________--- ________________