Homestead_Huelsmlan"'" CLAIM FOR HOMESTEAD PROPERTY TAX
, STANDARD/SUPPLEMENTAL DEDUCTION
�� T SUIe Fortn 5473 (R72 / 609)
�' / rresa;ted ny ure Departmem oi Lom� covemmeM Frerce
INSTRUCTIONS: See ravarse sida for (ili� instruc(ions.
FORM Y�
HC10
,.. -�l
� • . . . ;,
I(We) S f%N certi that I we occu ied as
fy ( ) P rtry (our) prinapal
place of residence or am (are uying the following described real property for which a Homestead Property Tax Sfandaid.Deductlon is herefiy�daimed
�er conVact on ihe date Utis aDP���lion is filed, (date of fi/in �� ';�, � i - �
9)� �JA.•'. \ 1
I(We) own ❑ Am (are) buying under recordee mntract ��! �; `;
❑ Am (are) entitled to occupy as a tenanhstockholder of a cooperative housing corparalion ���
❑ Have a benefidal interest in ihe Wst or,[he right to occupy the property under the terms of a qualified personal residence Vust
�
Name
Name of dairtairt'
(lasl five
If Wying om m�tred, Fre Simple axnnls rume
RetoNefs otfitB wherc mntrdG is
• �
ri
al daimant (lest five
DriveYS Gcente / Identifcation / Olhe
of daima�rt's spouse (la9 fiva dg2s)
Parcelnurt�ii er Itlesaiption
-�`fls / 3 - 3 -
tl any portlan W Ne residentlal 5t+ucW�e a Ne land nU eaceedirq me (1) aoe that
ol Ne yoperty utIDiad 10 produm �dr�e.
a� , /�-i�_ aUV_av/. � 9�-oas
Counry
Township
I hereby certify the above statements are We, correU and complete.
Atltlress
bteta, eM
land not e:ceeding 1(one) aerp Immedfatety
surtounCing resiCential improvements.
Olher land �
Total land (line 1 plus line 2)
Dwelling
ResitlenUal improvements or Mnually
Assessed Mobik I Manufacfured Home Garsge
Other improvemenb
Toql improvemenb (llne 0 Nr
Total value (Ilne 7 plts line 7�
I hereby certify the above is We, wrrect,
Veifying action - Sign2N2 oi PutlitOr
(�)
(Z)
(3)
(5)
(6)
(ej
sqraWre ot Assessw
�ssuv�g
RemrE numbu � Page
(riry: fown, townahi0)
-7 Is Ure property in W es�ion:
�/� Real property � MnuaOy assessetl rtpd'le Inme (IC 67. f-
fiateJy surtour�s �hat strucWre is used to W�uro inoortie. describe ihe use anE poftim
Caunry
20 pay 20 _ Lesser of 60% of the assessed value of Ne homestead or $45,000
Nolwilhs7aMmg eny afher P�'�sb�. ��m of fhe tleducGwu provitletl in IC 61. 7-7Y fo a mob�7e home Na1 is
rot esaessed as real propeM w to e manulacLUad hwna Na('a rpi essassed as reel popeRy may rat ezceed
Signature o/AUdIW
S
Tovrtahip
Date signe0 (rtronth. OeY. Y��
si9ned (mon+n, CaY.1Ta�