Homestead_Roberts (6)CLAIM FOR HOMESTEAD PROPERTY TAX
. __ STANDARD / SUPPLEMENTAL DEDUCTION
State fam 5473 (Rt3 / 12-09)
� y„ 1 P�escn"EeE by Ne DepaMrent O( Lof�i Gwemment Fuufxe
See reverse slde /or 6Lng insWctions.
FORM
HC10
i�
�(yye� — / �L �� l W 1i6�'A6��o6rAy�at 1(we) ocwpied as my (our) prindpai
place of residence w am (a buying.the following described real property fw whi a omestead Property Taz StanQ�' �D�uctia�hereby daimed
I
er contracl o� the date this application is filed, (date o/filing). 1(We):
Own ❑ Am (are) buying under recorded contract
C .'J. n'e�
� Am (are) entl0ed to occupy as a tenant-Stockholder oi a cooperative housing corporation
❑ Have a beneficial interest in Ne trust or the rignt to occupy ihe property under the terms of a qualified p�is���%ersi�iRldNv9UDITOR "•
❑ Am (arej the shareholder, partner or membar of Ne enfity that owns �he property.
Hame N daimant (lega� name)
:.,.;",I
Name of tla'unanYs spoise
spouse(6st
If buying om m�t2ct Fee Simple owners �me
Recordets oi6ce where mntracl is recorded
County
CounTy
3 �-�i�o0 0o�o�-t
' Me residential structure or tha IarM not
utifaed m produce Income.
Township
Orivefs ficense ! Identifiot
af daunant (lasf !rve d"gifs)
ot tlatrnanYs spaee (lestlrve dryts)
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-.e:_�tT�`�.�lR.:..?SS'�.�r*�3..:t:.rR�A.'��.'±.: y?��.
— �
ptian I Is � perry in 9uestion: �/
�/ Real pivperry ❑ Mnuelry essessee moh0e (IC G1.1-n
ceeding ane (1) ane Nat immediatey wrtountls ihat sW �re is used tn p'oduce income, Eewibe Ihe uu ard portion
I hereby certify the above sfatemenLS are We, corred and complete.
street.
Land not exceeding 1(o�m) acre Immedlatey
wrtoundi� resldentlal Improvements.
Othar lantl
rora� �and (r,ne 1 Wus rtrre T�
ResideMiallmpmvemenlsorMnualy ���Ing
Asaessed Mohle I Manufactured Homa Garage
Other improvemants
Total improvements (line / through line �
�1 value (line 3 pha Ilne 7)
I hereby certify the above is true, correct,
Si9taLire M /vitlibr
��)
(2)
(3)
(5)
(6j
��)
(8)
caunry
20 _ pay 20 _ Lesser of 60% of the sssessed valua of iha homestead or $45,000
NoMi7utand'ng any oMerpiovivon, Ne sum ol Ne deduct'an provided In /C 67.1-12 ro a lmbde home fAaf is $
not assessed as real poperty w ro e manWactured hortie Ne7 is not essessed as reel property may nof exceetl
a,e.r,enlim arhe asmssee,erue a ure rm6de nwne wmanwectrered nome. ._.
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