HomeMy WebLinkAboutHomestead_Overton (8)g"'" � CLAIM FOR HOMESTEAD PROPERTY�TAX
STANDARD/SUPPLEMENTALDEDUCTION
�• ' State Fartn 5473 (R12 / 6-09)
�O � PresuibeA by lha DepaNnent of Loral Govemment Firiance
INSTRUCTIONS: See revaise side (or filing insVUClions.
FORM
HC10
YEAR
° I(We) '' -' O{1 ceNfy ihat I(we) occupied as my (our) prindpal
place of residence or am re) buying the following described real property for which a Homestead Pmperty Tax Standard Deduction is hereby daimed
under conVact on the date Nis applintion is filed, �O ^/�- ei��0 (date o/filing):
� I QNe) own ❑ Am (are) buying under recorded contract . _ . . - ------4•- -.- —'- � -- ' '- - -
❑ Am (are) enGtled m occupy as a tenant-stockholder of a cooperative housing corporatlon
� Have a beneficial interest in �he wst or the right In occupy the property under the tertns of a qualified personai residence Wst
h V
Name ot (legal name)
Sooal Sewriry number o1 daimam's spause
��
H Miying om m�bact, Fee Simda ownefs name
Recoidefs ofice where mniracl is recorded
�
Drivers lirertse / Identifi�tion / O�her number
of daimant (lasl'f�' A/
ot daimam's
IIssuirig Sate
Iswmg State
_� �
Recad number Pape
�nry �. , . Tawnship I ' Ta�wg ALStriCt (City, town, township)
� ' h V� h ��b�v�. � r
^1 a um/pe Legal tles`xiption Is ihe property in qu�tion:
w/6•' "'/b '�O ��� b ❑ Real property � MnuaAy asussed modle home (IC 61.1-
(�Y
�tt any portion of Ne revOenUal sWCture w Ne WM nol esceeding one (1) aae Nai im�rie�iatety surtounds fhat strucNre is used to pfoduce irwme, desmbe the use aM portion
of Ne pmperry u9T¢ed lo produce inmme.
Counry
Township
I hereby certify Ihe above ste[ements are lrue, correct and complete.
Atldress (numDer an0 9reet, ciry, s(ate, antl ZIP cotle)
Land
acre immedialety
Total land (line 1 plus lina �
Dwelling
Garoge
Other improvements
Total Improvemen� (line 0 Nrough llne �
Total value (Ilne 3 plus Ilne 7)
I hereby certify the above is true, cortect,
and complete.
/aitying attion - SignaWR oflwtlitor
(�)
�Z)
(3)
(4)
(5)
(6)
m
(B)
tlaimant
20 pay 20 Lesser of 60% 01 the assessed value of the homestead or 545,000
Nolwiths�aridug eny atherprovisian, Ne sum ol fha deduUiwu prorided in IC 67.1-72 m a mo6de home Nat is
rmf assessed as ieal propeM a�o a menufeCUred hame Ne( a not assessed as iaal pioperty maY �t erceed
5
�
Township
Date signed (monN. daY. Yeer) _
Date signed (rtanfh, day, yea�
Oatc signeA (mmlh, tlay, yee�