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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R72 /609)
Frewibea M uie �eoertmern a Locai cwemmem Frence
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INSTRUCTIONS: See reverse side for filirg ins[mctions. � C� �� M"� �
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I(We) ' certiry ihat 1(we) ocwpied as my (our) prindpal
place of r idence or am (are) buying the following desaibed real property for which a Homestead Properry Tax Standard Deduaion is hereby daimed
under conUact on the date this apD����on is filed, (date of!ling): '
� I(We) own ❑!vn (are) buying under recorded contract
❑ Am (are) enGtled to occupy as a tenant-stockholder of a coopereGve housing corporetion
� Have a beneficial interest in the Wst or the right to occupy the property under ihe terms ot a qualified personal residence Wst
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Name o aimant (/egal nameJ �
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Sodal '
Sadal Senmry rwmba o1 tlaunanYS spdese (last (rve tligrts) Drivefs Gcense I Identifralion / ONer numbar Issu'ug State
of daimam's spouse (Ws! frve dgrfs)
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tl Wying on contra� Fre Simple mmefs rame �
Reoo�defs ofice where mntract is remrdeC Rcmd number Page
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Counry 7ownshiv ramg a(ciry, �orn. townshiP)
ParcrJ number Legal tlacription Is Ne p�operty m question:
' I proputy � Annua%assessetl moh'le home (IC G7.1-7)
H portion d Ne resitleniial sWCNre ar Ne WM nol exceeding rne (1 � ame Ihat immetliatety surtou�MS Uiai shuc9na is used to p�oEUro i�cane. desrn�Ge Ihe use and poftion
a ihe P�PeM u0f¢ed In P�uce irimrtre.
a6-ia-o?- �o3-ooa. � 3b'-oa� � `�
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Coumy Township � Counry Townstup
I hereby certiy the above stetements are We, cortec[ afM complete. ��18 � � �
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PdEre 6erandaheet.rily,slate,antlLPCOtle)
i 33� N-5em�tis� �f�nce�an r,v 7670
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Land not ezcceding 1(one) acre immetliately � ��in,��'�=�4 «"�.-5'�+"fk'-�`'�
aunounAin residential im rorements. � � -�x - -.+.'. '�Y��'�"`�'S�"��� �
��'',gs�"�`{��E
Other land (2) _a.�ti-,�',.�"-�'.«y;�'zwN
Tofal land (line 7 plus line 3) (3)
Dweilin9 i4) `".�°a i�A.;�����v'�''�,�y.st
ResidenUal improvements or Mnually "F`_ ��""� �� `rrq '�` �
AssesseC Mobite I ManufachireA Home �4 "� s`',�-.�s � *�i7��+�'
Garage (5) k-�sr..�-.....�a��,+�?Y."�.. �..
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ONer ImV�oveme�rts (6) � .;tf. ,*�.�,y:h��� -
Total improvements (line d fhroughllne 6j (7)
Total value (line 3 p(�s line n (B)
I hereby certiy the above is true, corted, Signature af Acussor ' oare signea (montn, day, yeen
and complete. �
Veifying a�m - SignaW2 o(AUditw Date si9^ed (monN. EaY. Ye�
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20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45.000
Non�UhsleMCg any ofherpro�.ixinn, Ne sum W the dedurJbns pro�itletl in IC 6f. f-72 to a mo6de hwne Naf is $
nat assessed es real poperty a ro a rrenuhacYUied home Ne( a nof assessed as real propeny maY rrot azcaed
one�haH (f2) W Ne essessed value W(he mo6ile hwne orrt�nufactured hcma.
Slg�ture MNWitnr • Date si9ned (rtronlh. daY•Y��)