HomeMy WebLinkAboutHomestead_AldenCLAIM FOR HOMESTEAD PROPERTY TAX
_ � STANDARD/SUPPLEMENTALDEDUCTION
� Slata Fortn 5473 (Rt3 / 12-09)
� PfesaibeE by Ne DepaNnent ol Local Govemment Financa
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INSTRUCTlONS: See �everse side for fiGrg ins6uctions.
FORM �
NC10
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1(We) �' certify that I(we) ocapied as my (our) prindpal
r� � ., —'--
place of residence w am (are) buying ihe fdlowing d saibed real property tw which a Homestead Property Tax-Stsndard4`Je\�ion is hereby daimed
ier contraG on the date ihis application is filed, (date o(filing). I(We): V v
❑ Am (are) buying under recorded conVSCt G�BSON COUNTY AUDITOR
Am (are) entllled to occupy as a tenenl-stockholder of a cooperaUve housing corporation
❑ Have a benefidal interest in Ne Wst or Me right to occupy the property under the tertns of a qualified personal residence Wst .
❑ Am (are) the shareholder, partner or member of lhe entity that owns ihe properry.
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rtannre d cwmant (lega� ^eme) � I � / D
she r
soeal Smciry nm�
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I Sewriry number
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If buyirg m connact. Fee Sirnple owners name
Recorders oifice where convact is recorded Reoord nurnher Pape
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Counry Township T' d' �(�. fown. ro»nshiP)
Pafcel number Legal desniption Is property in Question:
I propeJty � AnnuaRy assessed mob0e Iwrtre (/C bf. f-n
It arry portirn of Ihe residenilal strucWre or the IarW not excaetling ane (t ) ave Ihat irtunediate�y surtou da Ihat sWCLire is used b P�uce ukome. Eesaibe 1he use and portion
of Ihe proparty utilizetl m produfe Inmme.
� �-zz-ia- � ��� �9/-�ay
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Counry Twmship Counry TamsNp
I hereby certify the above statemenis are We, correct and complete. Signaw' o� aimant
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AdEress (number eM sGeet, ri(y, stafe, arci ZIP codej
�39a w Glo�.da(z . f. �¢c��s�ac(�. T� N7G39
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Land not exceeding t(o�re) aere Immedlately ��-''� �r,�. �'"' fi s� t..:� �-�>-
surtoundin realdentlallm rovements. (�) -'�-�,�--.-.*--'-'��'�-' =��=�,
-� tn �,:'�•x :� ..,..;??
:j`� : . -....i..c: �.r �x� , _
ONe! 18nd (2) -:.n"�'>=�:c. �`.,-`44.
Total land (line f plus llne T) (3)
ss-5' w ` a 3s � a..
Dweiiing (4) � � ° �'�'-�°_r.���"'�r� � �
ResldeMial Improvemen6 or Mnually .
ASSessed Mo6ile I Manufactured Home Gara e �'�'"-�� ;�-���� 5 r-r�- 4�'S.,f,`
9 (5) `-"�'i�s4 ��a-'_£`°r�: -�z�t':^ =r
-� 3`-^ i�1 [
Otherimprovements (6) U � _1,��"'".-
Total improvemeMS (Ilrre I Nrough Iine � (7)
Total value (llne 3 pl�a Iine � (8)
I hereby certi(y the above is We, corteet, �9^a�re o(Assessor Date signea (monfh, dey, yes�
and complete.
va�N�9 ection - signawre ora,dimr osm sqned (monm, dar. r��
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20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
NoMithstand(rg any oUrer povision, Ne sum o7Ne deducfiorts provitleE in IC 67.1-/2 fo a rm6�7e home Nat's $
rpf assessetl es 2a1 property a to e menWactured homa Nat is not euessed as 2al property may raf exceed ._
one�hall (f21 W fhe assessed veM W the moW7e home ormenulaUUrad home.
oa� 9s�ea c m. der,
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