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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
` � ` State Fam 5473 (R8 ! 7-07)
Prescribed by Ihe DeparUnent of Latal Govemment Finance
INS7RUCTIONS: See reverse sde for filing insbucfions.
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DEC 0 5 2008
�(h'e) "' �� that on ttie )si day o(fiiarch, 20
I(We) occu ed as au prindpal ptace of residence the folbwing described real prope which a Homestea��p�i ��i�iYi�ii�aQAaimed:
n I(We) ned ❑ Me buying under contraU
�Have a benefidal interest in the enfiry ihat is liable for tlie property taxes on the property and that owns the property or is buying under a contract.
If Wy'v�g on oontracl, Fee Simpe ownera rreme
conUati is recorded
Caunry
Paul numbei
Township
Is tha
Recwd number � Page
I �(�([yfZ� C�.I � I �--�"`�'� P�WBRY ❑ Mobile Fbme (IC 6-7.7-7)
If arry porGon o( Ure residerNal sWdure w Ihe fand nol e�cceedirg one (1) acre Ihat immediately wnounds that stn�cture is useC ta p�oduce inwme, describe Ihe use and pwtbn
af Ihe properry Nifized to produce inmme.
at�-I1-►y- ►oa cbl 5/Y Oa7
,_ , , . .. . .
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Land not exceedirg 1(orre) aae immediately "� � ' .,
surtoundirgresidentialimprovemenfs. (�) � � �� *�� . � . .
ONerWnd (Z� .. _ -
Taal land (line 1 plus 1'ine 2) �3�
. . � .' >
Residential improvemenis or Mnually �Iling (4) � �' � - '
f�55essed Mobile / Manufat4ired Home � '
Garage (5� - `..ya �
. ':�: r; ,�-:<.: ,> s, ,
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Olher improVements (6) y`.v:��-^�� �i:`.�,.�".:� •;'�:
Tctal imprwements (line 4 through Grre 6) �7�
Taal value (line 3 pl�s Grre � (g)
I hefBby [eftity the above is We, Cafed, efd Sigreture ofASSessor Date signed (monN, day, yee�
canplete.
Vaifyirg adion - Sipnature oi Putlimr Date signed (mmN, daY• Y��)
�.-� � � • •
PeY ZQ — q5,ppp for 2007 pay 2008 42,000 for 2010 pay 2071
Lesser of 12 qq.ppp for 2008 pay 2009 41.000 for 2071 pay 2012
Homestead VAuatirn S
� 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Pudimr Date signed (mmN, day. yea�
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