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""� CLAIM FOR HOMESTEAD PROPERTY TAX
- STANDARD/SUPPLEMENTAL DEDUCTION
stace Fortn sa13 (R1z � c-09> .
�� � Preulibed by the Departmanl of Lo�l Govemmenl Fnarxe
INSTRUCTIONS: See reverse side /or filing inuruuions.
FORM
HC10
YEAR
. �
I(We) certify ihat I(we) occupied as my (our) prindpal
place of residence or am (are) buying the tollowing described real property for which a Homestead Pmperry Tax Standard Deduction is hereby daimed
untler conVad on tha date ihis applicalion is filed, (tlate o/filirg):
❑ I(We) own ❑ Am (are) buying under recorded contract '
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation
� Have a benefidal interest in the wst or the right to occupy the property under ihe terms of a quaii(ed personal residence Wst
•• • •
Name ot daunant I neme)
Sodal Semiry
Sodal Securiry numbu
of daimanCs spouse (last (rva dqits) �
• ••� �
tl buying om m�trad, Fee Simple ovmers �ame '
RecoNefs af5ce where mnbad is recoNeE � . Recdd num6er Pape
..�. . � . �
� TownshiP Te�dng disbid (' , wns iP)
�r� ��� 9 legal AesaiO� . Is Ne I property �� ❑ Annuapy asussed rtwd'le imme (IC &f.1-n
�
If anY Portron d Ue resdentiai sWCtwe or the Wnd not ezceeding me (1 j acre lhat mvirediately wrtou 45 that 6bucN�a b useE b produca inwrt�e, desaibe tha use and partion
oi me wo�m � m �a� �m�.
-.• . �: . .
Counry Township Caunry Tmnuhip
I hereby certify Me above statements are We, wrteG and complete. 5lgruwre of daimam �
ress (numDer antl streel, afy; state, and LP cade)
�• •
� • � � • �
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l.and not e:ceeding 1(one) acre Immediately � '�����'�,*������ �.��
aunoundin resitlential im rovements. � � "^+. +�+
;� `}1r � z. � �
Other land (2) ; .�.�;;,�r� ..
ToGI Wnd (line 1 plus line 2) (3) -
�.'�'s �,"y. ' �- a�� � -%.S'h'�3' 'k
ResitlentiallmprovemenborMnualty ��ling (4) � ' «.,,��`4� � .���?"��
Assessed Mobik I Manufacwretl Home Garage (5) %�������`�
it� -[r+ +o,k+�, z �
Otherimprovemenb � (6) - �aTi� ���
7ota1 improvements (Ilne I Nroughline 6] (7)
Total value (!!ne 3 plus line n (8)
I hereby tertify the above is hue, cortact, Signature af Assssesswsm Date Wgned (monN, day, ysa�
and wmplete.
Ventym9 ection - SgraNre of PLCtw . Date SigneO (rxnM. daY. YEa�
�.-� � � • •
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,OW
NoMilhsferNfig eny atheipiouision, Ne aum a11he tletlW.bns provMed in IC bt. i-72 fo a moD�7e home Nat is $
nat acsessed az real property or ro a menWar�ured harrie fhat a not essessed as ieal ryoperty may rwt esceed
ono-hetl (7 Wlhe assessed rehre mo0de �ome wmanNarluretl Frome.
Dete sign ( , �
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