Homestead_Weber (9):,
\I
"'" CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD/SUPPLEMENTALDEDUCTION
� SUIe Fortn 5473 (R72 / 6-09) .
�� � Preuribetl by the Departmerit of Local Govemmerd Frence
INSTRUCTlONS: See raverse side /or fil'urg instruc(ions.
FORM
HC10
YEAR
� M'e) 2 Q Y certify that I(we) ocwpied as my (our) prindpal
place of residence or am (are) buying the following de 'bed real property for which a Homestead Property Tax Standard Deduction is hereby daimed
under conVad on the date Uis appliration is filed, (dafe of filing): �
❑ I(We) own ❑ Am (are) buying under recorded wnUact -
❑ Am (are) entitled to occupy as a tenant-stockholder af a cooperetive housing corporetion
� Have a beneficial �interest in the wst or the right to occupy the property under the terms of a qualified personal residence wst
0
., :
I� buying on contraq Fee Simple owneYS nama
RemNefs of6ce where mntract 6 remde0
�nry Tbwnship
Dmmfs Grnnx I Itlenti:ra�ion
ot Uaimam (lest five digiLSJ
omer's ficense / ltluitifiratim / Othe
of dairrenCs spouse (last !rva dgrtt)
Taring
� �._-��--,�v
Recad numbv Page
„ town, towri5hi0) n i .-. . �
Percel number Legal tlesai0� Is Ne property in question:
a�-� �-� s� -13 v 3- o �. i 8" l- o a� ❑ a�i wovenr ❑ n,���m� a�a �x ro„ce ��c si. �-
It any portlan W Ne 2sidenUal sWCW re a the Ia�M not ezceedirq one (1) aae Nat UnmedWtely surtourMS Nat struclure is useA tn pmdum inoortre, tlesm@e the use aM poftion
oi Ne property u0T¢Ed to protlure inmme.
C�.� � �D � � ���
��
TownShip
I hereby certity the above statements are we, cortect and complete.
Address (num6er antl svceS uN, ste7e. aM ZIP e)
�aSN l,t.)a l-Fers S�
. ,. ,
Lend not exceeding 1(one) acre Immediately
aunounding residential improvements.
Otherlantl
Total land (line 1 plus line �
ResidenUallmprovemenborMnually �����9
Assessed Mobik / ManutachireE Hortre Garege
Other ImprovemeMs
Tofal improvemens (fine 1 thraugh line 67
Total value (line7 plra line n
I hereby certify the above is we, wrrect,
and complete.
Vei/yi�y acGm - Sigrature of Audtv
Caunry
Fa rt13 J-a-n� �
(2)
(3)
(4)
(5)
(6)
�)
(Bj
SignaWre of Assessor
20 _ pay 20 � Lesser ot 60% of the assessed value of Ihe homestead or 545,000
AblwVh Wndug eny oNe�provisiwi, Ne aum o/Ne tleAUrlinns prot�dad in IC bf. i-72 m a mobde home Nat i5
not essessed es real propeM w(o a manufecfured hm�e Nef a nol assessad as mal poperty msY not exraed
onehe7 (121 W Ne assessetl rdfua W Na rtp6de home or manufactured frome.
TownsNp
� 7G �8
$
oate signea (monm. day, year)
Daie sigrreE (manN. daY. Y��