Homestead_Risinger"'" CLAIM FOR HOMESTEAD PROPERTY TAX
�_ STANDARD/SUPPLEMENTALDEDUCTION
` Stafe Fortn 5473 (R73 / 12�9)
� Presaihed by Ne Depar4nent of Lacal Gwertunent Finaxe
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INSTRUCTlONS: See reverse slde lor filing instn�Uions.
FORM
HC10
YEAR
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�(We) `{ S C.otin certiry mat � o�u� as y �p,{p'�,`aa�
place af res' ence or am (are) buyirg the fdbvring described real perty tor which a Homestead Property Tax Sta ard�educfian h� repy c�med
�er contraG on the date this application is filed, (date o�fJing). I(We): �
Own ❑ Am (are) buying under recorded contrect �AN 31 pp �Z
� Am (are) entltled to occupy as a tenant-stockholder of a cooperative housing corporation C�fr�-,��--
❑ Have a benefiaal interest in Ne Wsl or ihe right to ocwpy the pmperty under �he tertns of e qualified personal residence Wst-�-y •
❑ Am (are) ihe shareholder, partner or member of Ne entiry lhat owns the property. GIBSON i,., v V
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It buy'ug an contraa, Fee Simple owners name
Remrdels office wMSe co�trert is recorded Remrd numba Page
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counry Townsmo Ta�n9 disbirt (� . ro ip)
Partgl number Legal tlasaip6on Is the pr perty in question:
rtea� yopcvry ❑ nnm,auy essessea mo6oe mm�e pc 5-1. f-7)
It a�ry ponion of tlw residential sWCWre or 1ha land rwt ezceeding one (1) aae ihat trnmetliately sutmunds that strucWre is used m produce income, desaihe the use aruf poition
�Me property u611zed m produre Income.
�-aa-�a-�a o�a �ao da y
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County Tw�nship Cwi�h _ Townst�p
I hereby certiry ihe ehove statements are true, corred and complete. sig�wre of daimant
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Address (num6e� eM street, ciry, state, aM ZIP code)
I 3G v.► G (? t. ,�c� �-I�� � 35
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Land not exceeding 1 (o�x) aere 4nmedlatey �� � `r��� u "'� �� � �� -�`f:
surtoundin realdenNal Im roveme�rts. �� - � '��
r s �, ,��;
Other land (2) y'� _ , �'�
Tofal land (line 1 plus lilre � (3)
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ResidenHalimprovementsorAnnually �IIin9 (4) �t.����ft��s. ��r� � ��-(�.
Asseesed Mohiie / ManufaetuRd Home x�-��y .,t':«v ��-' .y-.F�.,.`�'�'' �`c s;
C'ara9e is) t.. �.. �n'�r� _.:�-+� . � .�: '�'.
Otherimprovements (B) s�'-*a�� � -�^;�'i'�<f:
Totel improvemeMS (lirre 1 through line 6j (7)
Total value (Ilne 3 plus Ilne 7) (8)
I hereby certlty the above fs true, correct, �9^a�+re ofl�ssessor Date signm (monm. dey, yeaA
and complete.
Vaiymg aGion - 3ignaWre oflwditw Date signed (monN. daY. MaA
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20 _ pay 20 _ Lesser of 60% ot Ne essessed value of the homestead or $45,000
Ndxithsiand'rng eny otherprovision. Me wm o(the Ce�uctiorts proviUed in IC &7.7-12 fa a moW7e homa fhat is $
not assessed as real pioperty w ro e menNadured fwma that is rat essessed as ieel property mey mt exceeE
one-heN(121 W Ne assessad velue W(he mo6de hwne w man�Aactured l�wne.
ture a "tor -- Qate 99neE (monfh. daY. Yea/)
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