Homestead_Jarboe (3)�
CLAIM FOR HOMESTEAD PROPERTY TAX
.-d_`�j�= STANDARD I SUPPLEMENTAL DEDUCTION
S:a:e Fwm Sa]3 (R15 / St<)
��t' PresmbeC by ihe pepanmer.t ot Local Govertvrcnt Fnance
INSTRUCTIONS: See ieverse vtle lor fJirg insfmc(ions.
FORM
HC10
i
YEAR
I
NOTE: iekplrone, Sorlal Secunry, tllive/s ticense, state iCenG.SCaL'nn a� fede2l iCenlificalion numbers are wn.5dential urMer IC G 1. f-f2-37. �
I(We) certify Nat I(we p d my o) p�n al
place of residence or am (are) buying e foll 'ng descnbed real property under wnVact for which a Homes;ea rope ax arwar
Oeduc6on is hereby Gaimed on the date Nis appliwtion is signed, (tlate of s" naturc1). yI(VJe):
❑ O.m. ❑ Am (are) buying under recarded contract. D�C 1 i ZO�S
❑ Am (are) en;itled to occupy as a tenant-stockholder of a cooperaWe housing wrporation.
❑ Have a benefdal interesi in the tr�si or the right to occupY �he property under ihe tertns of a qualified naLres" en �
❑ Am (are) ihe shareholder, partner, or member of the entiry ihat owns the property. I
R
Hame la�r.an� (legalnerre) �
I
Soeai Seuui:y �umeer o1 aai�r.am s sowze pav rne Cig.�a1 Dmerz ssnse i laerscr,ion i a.ner nimeer izvmy sas I
el tlavrant's spouse (la5 frve CqQS)
IiWryg om m�raq Fre Simqe wmefs name I
ftcmtlers c:5rn wTere cmlraq is remNeC Remtl nur.:Mt Page I
Cauiuy TownslvG • Ta�l^9 GsNd (a�Y. tmm. tw Ni➢) (
Parmln�mEC Legaltlesaie�tim - r � IIS4�epopeM1YinQUes:irn: I
. QMp �O�La��� QRealprope.ry ❑nmuaryassessedmooeetror.re(�G6t.t-n
�
tl aery pa• o( Ne �riEem,ial struCUre w Lhe lam rot u�NMig oere (t) ace c•a, immMa:eH wrtow�6s Nat s.euC��re e wW m pvG� vmx. EesaiCe Ce use aM ponim
W Vle P'�FerY �ti2eC ro C��uce vitm�e. I
2G-��-j6-S�oo-oa�. �oao -ooy
Saz, Caury, ana iow.u'ap Is da'unant vaa�,vig a homes:eatl?
I � Yes Q No I
I hereby certiry :he above statemen5 are we, mrtect, and comple;e.
X Sgnx.urcd ant I
Pneressolmnue(numoeierMSreei.ary,5are.emLPwCa1 Aaarc MvawtMmmes;ea].rta (n i sTCet.oly.4ete.ardLPmOe)
D � 3 �
Landno[ezcaedingona(7�acnlmmeEiatety I,�) I
surtountlin resitlantlal im rovemenb
OM¢r lantl (2) I
Total IanE (line 1 plus line � (3) I I
Residential improvemen5 or Dxelling (4)
Annualty Assessetl Mobile / -
ManuhchiraA Homa Ga�9e (5)
ONer improvemenm (fi) �
Total impmvemenb Qine 1lhrough /ine � Q) I
Todl value (line 3 pl�s line l) (8) I
1 hereby ceNfy Ne above is W o, correc( 55��se olA sesaaa� Oata sgneE (�ronN, Eay, ytan
antl complate. I
Vmryvg aeai - Sgra:ure cf Pudi:or I Da:e sg V(nvYJi, Aay, yea�
I
20 _ pay 20 _ Lesser of 60% of Ihe assessed v�ue of Ne homes:eatl or SC5,000 , I
AbMiNSfa�Ming any otherprovivon. Ne wm o7 the tlBductirns povitletl in IC G 1.1-12 to a mobile frome 5
Naf is not assessed as real prapeRy or ro a manu(acfumd homa Naf is nof assessetl as real properry mey
rrof erceed one-haH (12) ol fhe assessed value o( Ne moMle hwne ormanula uretl hwne.
Syiu^re NNtl.:« , Dre v9neE (r. tn. EaY.Y� I
DISTFIBUTION: Uigwl-Caun:yAUtl�w.FihSampedCOpy-Tacvyer
M�P
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