Homestead_Lamey (22)�
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"'" CLAIM FOR HOMESTEAD PROPERTY TAX
� _ ?; STANDARD/SUPPLEMENTAL DEDUCTION
SGte Form Si73 (R72 / 699)
� � PrescriDed by the Department of Lo�l Govemrtrefrt Frence
FORM _ ��
HC10
INSTRUCT70NS: S raverse side for fif'ug instructions. '
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I(We) certity that ��j,) o9ccupied as my (our) principal
place ot residence or am (are) buying the followinq described real roperty for which a mestead Pmperty Tax �1fd2rdeDe�u�i�jd hereby daimed
under conVact on ihe date this application is filed, (dafe filing): �
❑ I�(We) own � ❑ Am (are) buying under recorded conVad �a ��
❑ Am (are) entitled to occupy as a tenanastockholder of a cooperative housing corporation �g f�
� Have a beneficial interest in the Wst or the right to occupy the property under ihe terms of a qualifOd pe�ona�i��2iTriEekW�1TOR
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tt bu�vig rn mntraq Fee SMple o.mefs riame
RemrEers ofGce wtrerc mnUaa is remrtled � Retad numbu Page
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Counry Township Ta�g d�striG (mY• Mwn. Mwnshi0)
��� �. d � � Is Ihe Properry in queslirn:
❑ Rral pfoperty � Mnua%assessed rtrohile home (IC 61.7-I)
I( any portim W t�e res0enilal sUUCLire or Ihe la� not ezceed4�p me (1) acre Nat hnmediately surtourWS that snufYUre is used to pratlure Nopne, desalbe the use and portion
of Ne pmperty utifae0 to produm inmme.
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Ca�N 7o.m5hiD Caunb . Towrattip
I hereby ceNfy the above statements are we, cortecl and complete. ��"�� � �
t,
Adtlress (number aM 5hee4 �: �te. antl ZlPaode) .
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LanA not exceeding t(one) acre immed(atety `?f�� +��t�'�:s,?,+:,�y�i,� �.,
surtoundin residentialim rovements. � (» ��^.,�,r,.�J(.:��;?,g^�,�yr������
Other IanA . . (2) �,.,�,'�.���" -
7op1 land (line 1 plus line � � �3)
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ResidentlallmprovemenborMnually �����9 (4) -.�-��=.��x..���#'+�sC?.i�� *°^`s
Pssrssed Mobile I ManufacaircA Hortre �y..�i•,,�+" �.� ��x��y
Garege (5) si:�'-�'.s'SS�iSY='`',����:.�s{;3.. �
.�i^ ` "�✓+ .�..� £'
Other improvemenU (6) ' ;�„�z�' ys?� -;._.
f� ..
7atal improvementa (llne I Nrough line 6] (7)
Total value (llne7 p(ls Ilne n (8)
I hereby certify Ihe above is We, correct, Sigranue ofnssessor . pa�e signetl (month, day, ysa�
and complete. �
Vedyi�g acmn - 59�ture of FuQtor Date sigrietl (monN, daY.lTa�)
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20 pay 20 _, Lesser of 60% of the assessed value of the homestead or 845.000 �
NoNnN5laMing anY �er plovision. Ne sum of Ne tleQUCGUns proNded fn IC &7.1-72 to a mobib hortre fhaf As $
not assessed as real propeily w lo e manuFarlurad hdna Nat is not essessed es reel properry may imt exceed
wiehaX J olLre essess lue ol mobde /rwne w manu7acturetl fwme. �/[ �1
W of D���! d-y l�