Homestead_ZimmerCLAIM FOR HOMESTEAD PROPERTY TAX
-�,m�• � � STANDARD I SUPPLEMENTAL DEDUCTION
�'�:•' SG:ePOrm5q3lRt5/S1a)
- PresmMG�Y�ceW�entatLOralGavemmentFVU`rce
INS7RUCTIONS: See 2verse sde lor filirg insfnxfions.
FORM YEA
HC10 �
NOTE: Telephone, SoGa/ Secunry, dlivers ticense, stafe i0enti;seGOn arW leCeral idenG(salion numbers eia mn(Men6al unCer IC 6f. f-f 2-37.
I(We) ify that I(w my ( pn "pal
place of residence or am (are) buying ihe ollowing descnbed real p op under contract for which a H es; P
Deduction is hereby Gaimed on the da:e Nis appliwtion is siqned, (tlate o/s'gnamm). I(We):
❑ Oxn. ❑ Am (are) buying under recortled conVact. DEC ` 3�OI� �
❑ Fvn (are) entitled to occupy as a tenan4stockholder ot a woperalive housing wrporation.
❑ Have a beneficial interest in ihe wst or the right to occupy ihe property under the terms of a qualified pe onal residence rust.
❑ Am (are) the shareholder, partner, or member of ihe entiry that owns the pmperty.
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na,e o� d eu oesanamel dav�um
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�o �3-0� aoo-cx�.c�a3-c�.
Pa rvr�r.[a le�al0esmp.ion Ils• prope.ryina��
� eal a�ce�:Y ❑ nrn�aN azussea no�ie twme (IC bt.l-�
If af]' of Ne �esiCeNal s7umirt u tt�e lantl rot e:ts Wrg one (i) aae tNt vnneOia'.eN tlut s5ueum is usM :a M�� vco. e.Oescn'x �e �ae aw w�+m
e
W tne , u'.dzea to c��� viwme.
5as, Coursy, a'a iowwuo Is tla'unant va�5ng a home5.ead7
�Yes�No
o aavnam
I hereby certify the above statements are We, conect, and comple:e.
AtltlzssWmnaC(m�mDa�ardsGaeCC4y.Ya:e.eMLPmEe) rezsalvara:eE�r . .dafryl�+���r��-a'Y.ga:e.aNLPmde)
lSE1�oo I�AUBSTM�T ia�l�b39
Landnot¢iceedingona�t�acreimmatllatery (�)
surtountlin resitlantial im rovemenb
Oth¢rland (2)
Total IanC (line 7 plus line 7) (3)
Rasitlantial improvemenb or Dwellinp (d)
Annualty Assessetl Mabile /
Manuhcturetl Homa Ganga (5)
Other impmvemenb (6)
Total improvements Qine 4 Nlough line 6) (7)
Total valua (line J plis line n (8)
I here0y cerlify the above is [rue, correc4 SgnalrecfASUSSn Oa'x vg U(rsm:h, Cay, yea�
and compie[e.
Ve�(y'vgac,ion-Sg�uwreolPUCi:or ��'9 �
20 _ pay 20 _ Lesserof 60% of Ne assessed value of Ne homesteaC or 545,000 D EC 2 3
2�i5,�
NoM1ri' arMmg any other pmvivon, Ihe wm ol the tletluclions provitled in IC 61.1-12 ro e rtabile Irome 5 ����j
lhaf is � assessed as real p rty w lo a manufectureC hame Naf is not assessed es raal pmpeM may ���
rrof e e-hatl (iQJ o/ t e'assessed vaNe of Ne mobHe frana a manutacturetl hwne.
� . GIBSO C �OR
DISTRI9UilON: Qgvul-LaunryAUE:ot,FieS`ampeOGOpy-ia�paytt
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