Homestead_Heldt (3)° CLAIM FOR HOMESTEAD PROPERTY TAX
:��� STANDARD / SUPPLEMENTAL DEDUCTION
���y1y Su:e Porm 56]3 (R15 / St4)
'• �•� NewibN Oy tM OepaMrent ot LoW Goveer ne t Fuurce
INSTRUCTIONS: See reverse sidB7orllirrg insfrucfions.
FORM
HC10
NOTE: Tefephone, Social Secunry, drivers lirense, stafe idenuficauon erq federal IOenlificalion numbers are confidenlial �ntler IC S 1. 7-12-37.
�O...t'�\Q. ��e) b C��K1— L` !1�<�J7 i., f`7` IJd�C.� cenify Nat 1(we) �P (o ) PM � �
place of residence or am (are) buying the following described real property under contract for which a Homestea pe T Stan r
Deduction is hereb daimetl on ihe da:e this a lintion is si ned, �
Y GP 9 (dateW�u . 1 . �
�"Own. ❑ Am (are) buying under recorded conVacl. V q
❑ Am (are) entitled ;o occupy as a tenanFStockholder of a cooperaWe housing corporatiort DE,C 1 L L�
❑ Have a benefival interest in the [rust or Ne nght to ocwpy Ne pmperty under the tertns of a qualified personal residence ttust.
❑ Am (are) ;he shareholder, partner, or member of ihe entiry Nat owns the property. � ��
5aaa� SerLr.;y rosnEer ot tla�r.unt Ues r Ortf.$)
Na:x of tla•r.�aN'a z�wae (kgalneme)
Ca rr�����o���a��,,,��
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Iah. mxn.
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nuMa � Page
I numxr Lega� aesmp:an Is inRRa�� q�_opeM � v��+�
�alO�Ce�Y ❑ M-+u%assessMmox'elfn:e
� on of iM resiEeMiai s•.ruct�re or V�e IaM rol exceeCVg aie (1) aae WI immeOiY.ely w�muMS W( sVUQUre is �sM to pmpua ircune, EesmEe Ne �e ai
poaef.y �fdzetl m proauce'uxome.
aCo-��-oa — aoa a���. 3oa -oa�
��.aror�,
I hereby certify :he above statements are we, cortect, and complete.
�� S'�'� S
OtherWntl
Total Wnd (line 1 plus line 2)
Resitlential improvamenb or Dwe1M9
Annualty Ass¢ss¢tl Moblle /
Manuhcturatl Homa Gange
Oth¢r impmv¢menb
Toql Improvemenb (line a through line �
Todl value (line Jpl�s line l)
I hereby certify [he above is We, mrrec4
and complete.
�aJ�vgr -55vuireWAW�:u
(6)
(8)
daimantvaca'Jrg
❑ Yes Q No
�
�N `�� �� S
20 _ pay 20 _ Lesser of 60% of Ne assessed vdue of the homesteaC or Sa5,000
Abn�ifhstanding any ofher pmvisioq fhe wm at the tletlucGOns provided in IC 61.142 ro a mobrle Irome 5
thaf is noi assessetl as real pmperty w fo a manufacTUred hwrre Naf is rrof essessetl as real propeM may
lrot exceetl one-haH(12J oifie assessed vabe ol (he moh3e ho/m�e w manufartured home.
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WSTRIBUTION: 0^Snal - CouNY PLd^ar, FieSampea Co%-Taqay>