Homestead_Grubb� rt�n
?¢ :'e CLAIM FOR HOMESTEAD PROPERTY TAX
` � CREDIT/STANDARD DEDUCTION
` � j State Fwm 5473 (RS / 70-01)
Presrribed by the Department of Local GovemmeN Finance
INSTRUCTIONS: See reverse side for (iling insfr�ctions.
FORM
HC10
YEAR �
I(VJe)_�/=�l,fh/�Jd `( vlJ,/'YV�d�/C!� � J��"�� certif�thsto�th tstda -ofMa�_
I(We ccupied as our principal place of residence lhe following described real property for which a Homesiead Property T�c Credit is hereby daimed:
1(We) owned ❑ Are buying under contracl N 0 V 0 7 2002
�4ave a benefidal interest in the entiry that is liable for the property tazes on the property and Ihat owns thqproperty or is buyiqg under a conVact.
I( buyug om m�uact, Fee Simple ownefs name
Recordefs otfice where contraa is recorded
County
F"
:.:Tamship
fiprcel.pprn6e�O�/ j'""7� I egaltle��o�� �� '_3_, IlsthePro',
i _
.J\J--/ ..J, �JIB
It any ponion ol the residentlal swclure w the land not exceeding one (1) aae lhat imme0iately sunounds Nat
ot ihe properry utilized to produce income.
�.� � A.L
���iiv�iiiic
County To.vnship
I hereby certify the above statements are true, correct and complete.
7ress (numbei and streel, dry, s1are, ZIP code)
�zn'� 3�., ., 4 a A t0�.,..-e,.. ��.
Land not exceeding 1(one) acre immediately
surrounding residential improvements.
Other land
Total land (line 7 plus line 2) �
Dwelling
Residential improvements
Garage
Other improvements
Tatal improvements (line 4 through Irne 6)
Tcial value (line 3 phs line n
I hereby certify Ihe above is Vue, correU, and
complete.
Verityin9 action - Sig�wre ofluitlitor
20_Pay20_
Lesser of 1/2�meste
Valuatlon 6.000
Sgnature o( Auditor
Rewrd number
Page
�rty ❑ Mobile Homo (I.C. 67.1-7)
to D��uce fncome, describe ihe use antl pariion
— vp�-/
'�YCLAIMANTIN��OTHER'COUNTIES+ �� �:;��:Ji
County Tavnship
Sioo7ture ol claimam � /
r�itr.a_.i c ��� n.n...���
Q.e, z rv �{� �� r'
; -ASSESSED.VACUE . HOMESTEAD�� � `+St'»s���
� '� AT 100 /e OF.:T,N :. � VALUE _-. �' ��-*-'�`'� �''
_ . .. . . . .. _ . r �- ,a
(�)
l2)
(3)
(4)
(5)
(6)
(�)
i8)
Signature ofASSessor
S
Date signed
Da[e signed