Homestead_Jenkins (10)"' �CLAIM FOR HOMESTEAD PROPERTY TAX
�. STANDARD/SUPPLEMENTAL DEDUCTION
State Form 5473 (R72 / 6-09)
•S � Preunbed by Ne Department of L.oral Gwemment Frence
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INS I HUG I/UNS: See 2V¢!S¢ Sltl¢ !O! b(uNJ u1SWL(IDOS.
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I(We) (.�- cerli that I(we) occupied as my (our) prindpal
place of residence or am (are) bu � lhe Ilowing desaibed eal property for which a omestead Property Tax Standard Deduction is hereby daimed
under conVact on Ihe date Nis app ration is file4 (date of filing):
❑ I(We) own ❑ Am (are) buying under recorded conVact
❑ Am (are) enfitled to occupy as a tenant-srockholder ot a coopereUve housing corporation
� Have a beneficial interest in lhe trust or the right to accupy Ihe property under ihe terms of a qualified personal residence Wst
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If buying on contraci, F Simple s�ma ` _ � � � �y
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Recordefs ofice where mntract is recorde0 Remrd number Page
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Counry TownshiP Tatirg dis � , rown. tmvnthi0)
Pa`cel number Legal desaiptim Is Ne p�operry in question:
' S � 8 �Real property ❑ AnnuaOy assessetl rtioMle home (IC 61.1-n
tt any portion of the resetlential swcW �e a Ne IaM frot azceed'ug one (1) aue Ihat Immediatety surtoufWs Ihat strucN2 is used In produre imnme, EPSCribe the use aM poftion
of Ne pmperty ubf¢ed tn pfoduce inrvme.
� a�-ia-�S- aa�-oo�. 3s�- o�-8 �oo� ��05
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Courrty 7ownsttiP Counry To-MUhiP
1 hereby certify the above sta[ements are We, correct and complete. � ot tlaimam . '
Adtlress (number anJ street, state, erN ZlPcode) -
D o..�eM;,��+ S�• ,.� 6 Q
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Land not esceedtrg t(one) acre immediauty � a�`=��,y���' ��-�y Y'�
surtoundin residendal im rovements. � � �= �-- �" -s "• ���*
Other IanA (2) i`'�£==� `�����4
Total land (line 7 plus line n (3)
"j"`�.�' ..^ '�iK�'.:,�'� Y ur �
ResidentiallmprovementsorMnualty �����9 �4) ��. F�"'� �������� °3y�s3�
Assessed Mobile I Manufac[ured Home ��,-�.�:� "} g� ��,�' ��"'y?�rg�
Garege (5) 'T.;.a 'l.3 �n,=.i ,.r s�"-#rt..
' .i'f::a:•.<^�.,�C•k��2"�`.:
Other improvements (6) �,�; _;2` _s-,_.5a�?o`=;
7ota1 improvements Qine e thmugh line � (7)
Tatal value (line7 plta line � (B)
I here6y certify the a6ove is trve, corted, Sgruture of Pssessar Date sgned (monN, day, }rea�
and complete.
Veilying acrion - SigriaNre of /wditor Date signed (monN, Cay, yea�
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- 20 _ pay 20 Lesser o( 60% ot the assessed value of the homestead or $45,000
NotwithslaMin9 any otherpmNSion, fhe sum W the deductioru pmvided in IC 67.1-71 to a mobde Irome t�a( As g
rot assessed as real properry w ro a manufaUUred home Nat is rot assessed as real properry mey rrot exceed
one-t�all (f2) o! fhe assessed rdlue of Ihe mob' home w manufarlureC hortre.
SignaWre olPUditor
Date signed (monN, Oay, yea�