Homestead_Martin (15)CLAIM FOR HOMESTEAD PROPERTY TAX
._ � STANDARD/SUPPLEMENTAL DEDUCTION
State Fofm 5473 (R73 / 12-09)
� y� ! p�m'p¢� py the Depanmant of Loral Govemment Finaxe
FORM Y�
HC10
INSTRUCTIONS: Sea reverse slde for fiLng insWctions.
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� �yye� certiN ( Drindpal
place of residence a am (are) buyify.the follovring described real properry tor which a Homestead Property Tax Shandard Deduction is hereby daimed
�er ct on the date this application is filed, (date ol filing). I(We): D E C S 2���
❑ Am (are) buying under recorded contract C_�.n�,�
� Am (are) enUtied to occupy as a tenant-stockholder of a woperative housing corporalion
❑ Have e benafidal interest in Ne wst or the right to axupy ihe property under the tertns of a qualified p��r�s�dg��i s�UDITOR
❑ Am (are) ihe shareholder, partner or member ot the entity that owns ihe property.
•. , �
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If buying on wntra4 Fee Simple owners rwne
Reardefs oi6ce where conUaG's recarded Remrd rwmbr! Page
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County Township Ta�drg distriG (�Y• town. townshiP)
� p:� = /�,� al pde�svi tian Is tha pmperty in question:
�'— W 'V ❑ Rea� vroputr ❑ amueM assessee mome nome ��c �v�-n
it am portion o/ the fesidenUal structure or the IarM not exceeding ore (1) aae that ImmeOiately surtounds ihal swmre ¢ used to pmdum u�come. desaibe the use and portim
of the pDperty WT¢ed to proAUCe Income. �L
� l�� IE7
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Counry Township � C,a�n1Y T�'^�P
I he2by certify Ne ahove statements are We, corteG and complete. Sigre�ure ot ima
i
AtlOress (nu be/ erid sbeef, city, state, and Z/P oode)
d�N• W��'LN?O Si T�K^y s�✓ �7(j �� �%80
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Lantl not exceeding 1(orre) aere 4nmediatey � ���`` �" '� "�"s �"+-� YF�
wrtoundin resldenUal im rovemerrts. �) �`4� 4���+Y §{`�`s`���
Otherland (2) � � ;%'4;�xr'F
Total land (line 1 plus lirre 2) (3)
;>� 3 �� a:.� � .
ResideMial improvements orMnually �Iling (4) '!�-> '-��g> . _y�-��-„�;� "�,-,
0.5sesaed Mo6�e I ManuFacWred Home ��98 (5) �; :�-�'�'y' .S�"� -�`��;�;,vi
>�,'3' _��-.C3s,,. � _ _ _
Other Improvements (C) r 2�.r
Totel improvemer� (Ilne I Nrough line � (7)
Total value (lirre 3 plts Iine � (8)
I hereby ceRify the above Is We, corre�t, �9"a� of Assessar Dafe sig�e (monN. day, yea�
and wmplete.
venw�a awm - siyna�u�e oraw�wr oam sig�a fmonu,. dar. r��
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20 _ pay 20 _ Lesser of 60% of Ne assessed value of the homestead or $45,000
Noh.iMSiendbg any othe� provisiai. fhe wm dthe deductbm provided in IC bf.1-f2 to a rmW7e M1ome Net'a $
not essessetl as reel property a ro e menWxtured home Nat is not essessed as mal property may rrot erceed
are-hetl 7/!1 o/Ne assacted rdlue d the moWe fame or menWachircd Awne.
Signahua of /Wdi[or Date signed (month. daY• Yea�)