Homestead_Knopf�'"'" CLAIM FOR HOMESTEAD PROPERTY TAX
!�_,. 'A; STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R72 / 6-09)
` � Prescribetl by Ne Depanment ol Local Govemment Friance
INSTRUCTIONS: See raverse side far filing instructions.
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APR 1• 9 zutU
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� M�e) • certi�p�n�ienQeupi�a�mf�om'IPrindpal
place of residence or am (are) buying the tollowing scribed real pro Ay r which a Homesiead Pmperty Tax Standard Deduction is hereby daimed
untler mnUacl on the tlate this applicatlon is filetl, (date o(filing):
❑ I(We) own ❑ Am (are) buying under recorded wnVact
❑ Am (are) enUUed to occupy as a tenant-stotkholder of a coope2live housing corporation
� Have a benefidal interest in Ne trust or the nght to occupy the property under the tertns of a qualified personal residence wst
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Nama of da' nt (legal name)
Sotial Seanity wrtiCer of clam�anl (6st dg2c) ' ers Gcense / Itlentifretion /
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Name of daimani's spouse (legal eme)
Sodal Secunry n bu of tlalmanfs spous ( d'gits) Drivefs Icense I ICenGfiralion I ONer number Issuing State -7
�,[ � of daimanCs spouse (1as19're dgittJ � j" �
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11 buying om m�trad, Fee Simple owners name
Remrdefs olfire where mniract is recoNed Remrd number Page
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Counry TownshiP Tazing tl' iri . fown, fown.NrP)
Pa`cel num6er Legal desaiptim C�. (o(O /q �, Is �he D�Perty m puestion:
,s(�.� ' � Q Real P�VenY ❑ Mnualty assessed mobile home (IC 6-f. f-n
�If any ponion of Ne revdentlal swcwre or Ne IaM not e:ceeding rne (7 ) acre that immediatery surtaunds ihat sWCWre is used In ryodufe irn�ne, descriDe ihe use and portion
of Uie pmperty utifaeC to P�uce income.
a�-la-o�- 300- �o3.s3�-��7
..� . ,: . .
Caunry 7ovmshiP Counb 7own5Np
I hereby certify the above statements are We, cortect and complete. s�na�ur�,�y� imant � �
y �; ,
MEress (numDer and strect, ary, state, antl LP
S a?� F_ �i ' fo � 1• ` �� i c 2�-%i-. �7 (o "7 0
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LanA not e:ceetling 1(one) acre immediatety �� rM1f,^�'� .s+ta'� y-;,5` r,��.'�,.s-,
surtoundin residential im rovements. ��� `�'�v����;.r��=_� = _-;..:�:.c:.-,
Otherland (2) � h.r�'��*���v .
7ota1 lantl (line 7 plus line n. (3�
Dwelling (4) ay �a.. 4� > >� -.�`` �
ResldenUalimprovementsorMnualty -T-= -�"-��-?F"�'�-�'-�-�>=��`�
Assessed Mobiie 1 Manufactured Home Garege 5 �� �'° ����'�' `�Y�
( ) C''�rx s ���'�a :�.'r_o »�'�.-.
Other impmvements (6) �y �;.i ry�T �.�?.
7otal improvementa (Ilne 4 Nrougn line b� (7)
TaUI value (line J plla line � (8)
I hereby certify the above is true, corten, Signswre o�nssessor Date signed (rtronth, day, yea�
and complete.
Vaityi�g actian - Sigrayre of fviditar Date signed (mmN, tlaY. Ye�)
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20 _ pay 20 _ Lesser of 60% ot the assessed value of the homestead or 545,000
AbM�ilRtfaM4g any Whe�pmNSion, (fre sum o/ Ihe dedur.tions provided in IC 6f. f-12 to e rtab0e Mme Uut is 5
rpt essessed as real property w m e rrenufatlured hmre Nal is not essessed as reel property may not exceed
ono-haH (1R) d Ne assassed value ol Ne rtabde fame w manutartured hm�e.
SignaWre itw Date signetl (monN, day, yea�