Homestead_Bennett"'" CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
� STANDARD/SUPPLEMENTALDEDUCTION
°�..�� S�ateFOrmsa�a(Riz/s-w) HC10
°' ✓ Prewihed by lhe Departmen� of Laal Govemment Firence
INSTRUCTIONS: See raverse side forllirg instiuctions. � �?f i� �
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I(We) certi(y that I(we) occupied as my (our) principal
place of residen or am (are) buying the following described real property (or which a Homestead Pmperty Tax Stultla�tl �d%tia��Giereby daimed
under conVact on the date this appliqUon is filed, (date o/(ling):
❑ I(We) own ❑ Am (are) buying under recorded conVact �� ��
❑ Am (are) entltled lo occupy as a tenant-stockholder of a cooperative housing corpo2tion
� Have a benefidal interest in the wst or the right to occupy the properry under Ne terms of a qualifle�r��al Fes�Benee'VUqiDITOR
•- • •
Nam of nt ( � a )
Sodal '
Narn tla' spouse (lepa/ neme)
' Seamry rnimCrl
��
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If buying om m�ttac4 Fee Simple wmefs iwne
Reoordefs ofice where mnVaa is mcorded Rem�d number Page
. _ � . _ � . �
�y Township Ta�dnp distrid (' lown, i �
�r1 mber �O M�. I O� P� Is e pm0e n question:
p Z.V al propeRy ❑ MnuaOy assessed mobile hOme (IC 61. f-7�
tt any portion of the revdential sWCwre or the IaM not exceed'ug one (7 ) ave Nat immediately wrrou s Ihat slrucNre is used to produm Uroorne, dewibe Ne use and portion
of the p�operty utif¢ed b padure inmme.
-�• � �: • •
Caunry Township County 7ownship
1 hereby certiry the above stetemenu are we, correa and complete. 5, yr�e�ure o1 da nt _ �
1CJ
i /
ess number an0 street, dry, stafe, entl LPcada)
'� 0 2o VA[.u:Y aS.s f'��°�r��� 1� `I7b
. . .. . ,
�- • �� ..
surtound nY residentiel m) ro e e�diatety ��) ��? ��Ky"p ��,��,3�'"F _`'v m�" �.L
Other land (2) '�'; s,�,'�si'y�; �,�.;����
Total land (line 1 plus line � (3)
. .s�..,� ,-m� �. r , k..
Residential improvemenGa or Mnualy �����9 �4) h F� � ��� �
^,*s 1 EiR:-�'�'t � :'�r�s
Assessed Mobile 1 Manufacturetl Home Gare e '� `�+`�3C+���-� "�j��°
9 �5) �-.?�..c.. ?s:�`FC�'a��.. .�i.:�''s.�'.
Other improvements (6) _t�=:��+�,r��.',`�,.�,F:�,�1x
ToUI improvemenfs (Ilne 4 fhrough 17ne � (7)
7otal value (ltne 3 phs Ilne � (8)
I hereby certify the above is true, correct, Signature olncsessor Date signed (month, day, ysa�
and complete.
Veily'uig acvon - 55rewre of Pudmr Date s9n�M (rtronN. tlaY. Y�
�.-� � � • •
20 _ pay 20 Lesser of 60% of the assessed value of ihe homestead or $45,000
Nofwi(hstaMing eny otharpmvision, 1he sum o! Ne dedurlions provided in IC Gl. f-7Y fo e mobde Mme Ihaf is g
rrot sse.ssed as real properry a Io e menuFaUUred home Nat is not assessed es real pioperty may not erceetl
atl(12) d fhe a lue o! the mobile fwme w manufartwed home.
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� Date 59 d Y. 3Ts