Homestead_Smith (24)CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD / SUPPLEMENTAL DEDUCTION
State Porm 5473 (R72 / 609)
�O � Preulihed 6y lhe Departmerrt of Lual Govemrtrerrt Frence
WSTRUCTIONS: See raverse side fw fil'ug inshuc(i0ns.
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JUL 13 2011
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� i�`�e) � �- cerlify thal�(gg�.��s�r�y (o ri�,apal
piace of residence or am (are) buying the foliowing described real property tw which a Homestead Property 7ax Sfandard Deduclion is he�t �ed
� under conUad on ihe date Ihis application is filetl, (date ol filing):
❑ �(We) own ❑ nm (are) buying under recorded mnvact
❑ Am (are) entilled [o occupy as a tenanastockholder of a cooperative housing corporetion
� Have a benefidal interest in the Wst or the right to occupy the pmperry under the terms of a qualified personal residence Wst
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If W�ing on contraq Fee Simple owners rame
Reoortlets o:GCe where mnVap is recordeO Record number Page
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Counry / Tawnship � Tazing " q ( ' , (ax�n, townshrp
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Pam.d number Legal desoiptian Is Ue perry in question:
Real pmperty � Annua%yssessed mo6ile home (IC &f.1-7)
tt arry portion W Na resdential swmra or Ne WM nol e�¢eedi'q one (7) aae that immetliatey surtowMs that smuWia is usad to pmCUm IMUna, EesMbe the use aM portbn
� ot Ue praperty wT¢ed N p�oCUCe incoma. -
- � - a�-�.�-3� _��� �03. ��r ���
... . . : . .
Counry TownshiP � Counry . Township
I hereby certify the above statements are we, corteG and camplete. � �"a� "�""a"� ' �
MEress(numberandsheet,crty,state,eMLP a) •
� S , r � � , ,� cc' %o.v „ • 767U
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LanA not ezceeding 1(one) acre immediately �T+.`y:�- i�_ i"��-"�:^�` ?,i-:`:
surtoundin resltlentialim mvements. i�) '��"�=�"�.�y�^'�s .•,
�i,�z �s: -t.�,�':....:..- -��.ir�
Other land � 2 �' �"f�{���Y�"��-"
� ) ��i"'Y�-.v�''. ..�`r,
ToUI land (line 1 pfus line i) (3)
Dweliing (4) `=$.�.n�'.,'" r �''.'"<.s�`'y5+�??�
Rcsidentlal improvemenb or MnuaUy ?�`+� �`�� ^� '+� � .�:. -< �t
Avsessetl Mobik I M1lanufacNred Homa Garsge (5� :E�����.g ��*- 3+�� ,=�sk^�'
r�. X'�Krs'r�..t �a: h'�.�'.�i'�xY�
ONer Impmveme�rts (8) � "s�y:�;�;:.T.��� .
Tofal improvemenb (Ilne 1 fhrougA!!ne � (7)
Total vatue (Ilne 3 pl�a line 7) (8)
I he26y certify ihe above is W e, wrtect. Sig�ture of Assassar Date signeE (month, day, year�
and complete. . �
Vailying acUm - Sig�N�e ot fvidlin Date signed (monN, day, yea�
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20 _ pay 20 Lesser of 60% of Ne assessed value ot Ne homestead or 845,000
NoMi(M1Wnding eny otherP/o��. �� a� e��.a O�d in IC E7.7-71 fo a mob0e Ipme Nat 45 $
not essesscd es real pvoperry w to a menufactured frome Nat a rot assessed as real properry may rpt ercee0
one�haH (1R) W Na assessetl re/ueW Ne mobde home ormanulaGUred Iwme. '
Signature o(PU01tor Date si9�ed (rtanth. daY. Y��