Homestead_Briggs�
�:._^'" CLAIM FOR HOMESTEAD PROPERTY TAX
� STANDARD / SUPPLEMENTAL DEDUCTION
Sqle Fortn 5473 (R72 / 609)
�'' � Pre.scnbed by Ihe Depanmem of Loral Gmemment Firiance
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wsrRUCnoNS: see ,���e srae ra. eu� r„s�ti���„S. A P R 2 Q � u i u
� M/e) J �' . . certiry that I(we)� ' a r) prindpal
place ot residence or am (are) 6uying the tollowing described real property tw whi a Homestead Properry Tax $dard Ded�on is h y daimed
under conVact on the date this appliralion is filed, (date of filing): �OSON CO�NTY AUDIT��i
❑ I(V✓e) own ❑ Am (are) buying under recorded conVact �
❑ Am (are) enUtled ro occupy as a tenant-stockholder of a cooperative housing mrporatlon
� Have a benefidal interest in Ihe Wst or the nght to occupy the property under �he terms of a qualified personal residence Wst
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II buying on contract, Fee $imple ownels riame '
RecoMers offifx where mnVad is remrdeG Remrd num6er Page
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���y Township T' Aisihct (ciry, rown, rownship)
Pamel number al d mption G�d ��� , L 9 a Is Ne property in Queslim:
' L� �Rea� WoDertY ❑ AnnuaOy ass�sed mo6ile home (IC G7. f-n
If any portion o1 Ne residenlial swcWre w Ne IaM not exceed'ug one (1) aae Nat immedia[ety surtwnds Ihat svucWra's used to produce iMame, describe the use aM portion
of the pmperty utif¢ed tn pmCUCe iMOme.
a!o-�a -o � -303- o o�(. 3r�-oas
-.• . .: . .
Coumy Township Caunry Twrt�ship
I hereby certiy the above statements are We, correct and complete. Siynamre ot aaimsn� �� � �
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�/ Address (numDer antl street, tlry, stete, and ZlPCade) �/� / � ' ' /� � �/G 4 /J.( //'�J/ � G � � �
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Land not e:ceeding 1(one) acrc immediatety � � 7�fa� { 54.;�`, �*` `"`:?� .,
surtoundin residentialim rovements. ( � �=1:=--i,»i =-.-�'-M:=+�>-��:f��=
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f.t-1--,'.3�°.`�"'r,`jTiS:".:`,rg�
ONer land (2) G".-}[=h1.'.'�e'�`,�-::fr
Total land (line 1 plus line � (3)
�.° �-L�, t.}�.A i � . Y_u . .
Residentlal improvements orMnualty ��ling (4) °„�: � �a�i,�` �'Y tt:`�v3
ASSessed Mobile / Manu(actured Home Ga�ee �5) � X�� 4 "� � �' ��� ;r� �?
Olher improvemenis (6) ir �Jt _ .i � y Y •� _
Topl improvemenia (line a through line � (7)
Total value (Ilne 3 pl�s line n (8)
I hereby tertify ihe abave is true, cortect, �"a�� °f �� Date signe0 (rtronN, day, yxar)
and complete.
Verifyi(g action - Sig�uNre W Audfw Date vgneE (montfi. day, yea�
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20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
AbtwilhsfaMirg enyWher pmNsion, Ihe wm o/the deduc(bns provs/etl in IC 67.1-f2 to a mob0e lame that is g
rot assessed es real properry w to e manuFdUUred home Nat is not assessed as real pmperry maY �I erteed
ane-haH (12J o/ the assessed value W Ne mobde �ome or manufactumd home.
sig�wra ot PWitw ^ oate si9neE (rtanth. daY. Y��
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