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"'" CLAIM FOR HOMESTEAD PROPERTY TAX
� STANDARD/SUPPLEMENTALDEDUCTION
� ~ State Form %73 (R72 / 609)
�'` : PreunCed by Ne Depariment ol La:al Govemment Frorce
INSTRUCT70NS: See reverse side �or (ling insvuctions.
�
FORM YEAR
HC10
a,�-�3�-G,��
I(We) �� � ui=� certi(y that I(vre) occupied as my (our) prindpal
place of residence or am (are) bu ' ihe followi described real property fa which a Homestead Property Ta: Standard Deduclion is hereby daimed
��u,,,n[der mntract rn the date ihis app ication is filed, (date of filing):
XC I I(We) own ❑ Am (are) buying under recorded wnVact
�Q Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation
� Have a benefidal interest in Ihe Wst or the right to occupy the property under Ne tertns of a qualified personal residence Wst
Name
11 Guying an contrac4 Fea Simple wmefs �me
ReooNefs o(fice where mnvacl is remNed
Counry
PairPJ
{prpu9TaeG b P�ure mmme.
V�
- �3 �� - aoo
Counry
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Recad number Page
•
rid (c�; town. township) �
9�—L(�l � �f—�
Is e p perty in pues6on:
1�Real property � a+�ualty assesud rtwbile home (IC &7. f-n
wn s Nat swcWre's useC to ryoduce i�roome. desai0e the use and portion
• ' •
Township
20 pay 20 _ Lesser of 60% of the assessed value of lhe homestead or 845,000
NofwdhslaMirg any other➢��^�, the 5um of the deduciions yovidetl in IC 67.7-11 fo a mobDe home Ihaf is g
rot assesseE es real property or lo e manWaCUred home Mat is not essessed es real properry may rof erceed
one-hII(7Rla� s�u� 1 olNemo6ilehomeormanutacturedhome.
SigreWre of �LWitar
Date sk)ned (mmN, Oay,
Date
Date signed (monlh, day,
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