Homestead_Cochran (5)�
"'" CLAIM FOR HOMESTEAD PROPERTY TAX
�, ._- STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R1T / 609)
t' � Presc�ibed by Ne Department of Lo�l Govemmenl Fraxe
INSTRUCTIONS: See raverse sitle !or filirg instrtiUions.
FORM
HC10
YEAR
� (We) � �-- ' fhat��i opw��as,r�y (our) prindpal
place ot residence or m(are) buying ihe tollowing described real properry tor which a Homestead Properry 7ax S af0 d wn is hereby daimed
under conVac[ on the date this appfipUon is filed, (tlate of filing): •
❑ I(VJe) own ❑ Am (are) buying under recorded contract ..,
❑ Am (are) entiLed to occupy as a tenanhstockholder of a cooperetive housing corporelion q�8R O�� Nl7��LJ ITOR
� Have a beneficial interest in the Wst or the right to occupy the property under the [ertns of a qualifiedper�6nal �dence Wst
Name
Socia� seauiry
�'�
Spouse
If bu�'v�9 om m�tra4 Fre Simple ownefs �uma'
Recorders office where tontract is remde0
Cqunry , n A � Township
urnPls 4LeRSe I wPnUtIWUOn I(Me!
OtrveYS Gcenu / Itlentifitation / Other m�mber
of daimarrt's spouse Qasf flva dgds) �%�/
Is
If arry portion W Ne reSNen�lal s ar t ezceedug ane (1) aire Nat ImmedWtely surtwrMs
af �he PmPanY U�T¢ed N P�uca inmrtre
��-�a-o�- t�� d b �I.3� g-oa�
Counry
Tovmship
1 hereby certify ihe above ststements are We, cortect arM complete.
Land not e:ceedina 1
Otherland
7otal land (line 1 plus line 1)
Immetliatety
ResidenUallmprovementvorMnualty �����g
l�ssessetl Mobik I Manufactured Home Garage
Other improvemenb
Total Improvements (Ilne 0 Nioug� 17rre 6j
Total valua (llne J pl� Ilne 7)
I hereby certify the above is We, cortect,
and wmplete. �
Vai(ying atlion - Sigretwe of fu�61w
(2)
(3)
(4)
(5)
�)
IB)
Sgnatu�e of Pssassar
Caunry
Reowd number
Page
rertYmWeslion. – �—
� P�CenY ❑ MnwBy assessetl moWe Mme (IC 6f.1-
SbucNra is useE to Oioduce incvrt�e, tlevnbe the use antl portion
ZO _ pay 20 _ Lesser of 60%� of the assessed value of the homestead or 845,000
NuM1Uilhsternfu+g anY �rprovision. Ne sumW Me tledtxlions pro�idetl in IC 6f.7-17 ro a mobde home Naf is
not assesseC es ieal property w to a manutectured hortre Nat a rpt asseued as reel pmperry may not exceed
oneJ,afl (iqaer Ne assessed valu¢ W fpi mo6ip�Awne a manufacture0 home.
�
$
TowR.hip
L
Date signeA (rtronfh, tlaY Yae�)
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