Homestead_SiskCLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
State Fortn 5473 (R6 / 4A3)
Presuihed by Ne DepartrneM N Locai Govemment Finance
INSTRUCTIONS: See 2verse side /or (ling instructions.
�
FORM
HC10
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�� ��YE�AR _;;;
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_ 1
I(We) llL�!�•L�C�(� �-C�.l�/� � certify Ihat on the tsl day o��Aarch, 20
I(We) occupied as our principal place of residence the (ollowing described real property for which a Homestead Propert Tac Credit is hereby daimed:
�e owned ❑ Are �� � '6 �
(W ) buying under contract a e
. Have a benefidal interest in lhe enfity ihat is liable (or ihe pmperty taxes on the property and ihal owns tlte prop�rt��u�i�kT�d@ con[ract.
s.? v��'r.�.�FC'„'.`-r�i.r'� s: �°� 2�"+'�.? s�-1s� , .c, r,- -�''i: r��.`<CONTRACT'.RECORDED - � ,�z.,. .� . �s� -c. . -�, c ..r....
Y . .:.Sa._r _ 5�.,� ;�:s.�_,..��.��- '
I( buying on conirad, Fee Simple owners name
Recorders olfice where conVad is recorded Record number Paqe
��h
Parcel number
Tawnship
Taing dis ct 'ry, tow,r, ro
Is the property in
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❑ Mablia Mwno (I.C. 67.
If any ponion of the residential sWCture or the land not ra�ceeding one (1) aae Ihat immediatety sumounds that sbuaure is used b produce incoma, dewibe Ne use and portion
ot Ue property utiized to produ incame.
�'� �9-30-��o-aa�.�ai-��
��3'?�� ,A�SSESSORUSEONLY,_:'����^��iTVALUE } ��AT1E00°/aOFTN�''yH�VALU7EAD� NON-RESIDENTIAL�'j�A�
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a�'A'F.�,'v'5.,....n tt a�':"35 , a � 4��.':� `s�. � q aY`..'_'#'7<.- .,..=Y.,.. ��isa�i�ly-�.:." VALUE'� �,,.�."r.
Land not exceeding 1(one) acre immediatety �i� v�'i';;'��° �'�.y:��s- �'�
surtounding residenGal improvements. (�� ���-,��� Pf%�.��,�-�..�_ ���� �'
�ssi, �3'L_^�L Fra_ . Yx.Y �:`•
. -.���._.....Y.�,-.
Other land 't:.l:°::�rW.s;_: :uh�F
(Z) i "•'.:'.�: 7i; _ :�'rJ�'.:``;�:
. C,-�'i.'.:i"_J-"�c. .�
Tcfal land (line 1 plus line 2) (3)
- � .,.-'�.�� `�`` k�y�� u'.-''i
Dwelling (4) �k�-�a� d-. ��' �! r
�ResidenGal improvemenLS or Mnually £'"'�`�u'�' �'"��������
Assessed Modle / ManufxNred Home Gara e ��r� ���� ��, ?
9 (5) �x �.,=-�'� `arR#�'�����G
� T��* ``eY..
Other improvemenls (6) t �,� � z;�,
�.."S4�N�v.......
Tcial improvements (line 4 fhrough line 6) ���
Total value (line 3 phs line n �g)
I hefeby certify the above is We, coneIX, and SignaNre ofASSeswr Date signed
complete.
Verifyirnj actbn - Signature of fwditor Date signed
°:u'�"��'4�0�.'`... .�;,�"�'��.'-!:'i'tr _� . ��,``s:S?��.�:-r:STANDARD:DEDUCTION�ALLOWAIiCE z.� ax�u`�.� =3i!:..';�w...�'e;� xt zLx�?.E� ��a `'�'s����a=,`.-.
20_Pay20_
Lesserof 112 Homestead S
vawauon w 535.000
Sgnature of Puddor � Dale signed