Homestead_Coomer (17)�•, _n ��;
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn Sa73 (R72 / 6-09)
Prescnbed by Ne Departmenl of L.oml GovemrtieM Fnence ,
FI F
HC/0
MAY 1
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lNS7RUCT10NS: See reverse side !or filing instrtictions. " C.�.
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,I(We) certify that I(we) occupietl as my (our) prindpal
place of residence am (are) 6uying the following descrihed real property tw which a Homestead Property 7ax Slandard Deduction is hereby daimed
under conUacl on �he date lhis appliption is filed, (date o7blirn,7):
❑ I(We) own ❑ Am (are) buying under recorded conVact
❑ Am (are) entiLed to occupy as a tenant-stockholEer of a cooperalive housing corpo2tion
� Have a beneFlaal interest in ihe Wst or the right to occupy the property under the tertns of a qualified personal residence Wst
•- • •
Name o mum (kgel name)
SoWI Seduity of tlaManl (H5f R.e pdigipt) Orivpls Ikenae / Identifiplion /
�
Sodal Secunry number of daimant's spouse (las! five O'gds) Drivers ficertu / Itlentifralion / O�her number • IssuNg State
� o( da'una�rt's spouse (last (rve dgi6) '
� • •-� �
If buying on contract Fee Simple wmers �ume
Recordefs alfke where tontraG is recordetl � Recard num6er Pa9e
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Counry TownshiP T�istrid (ci13: Mwn. townshiP)
PerceJ number Legal destriP� p �5 � G Is Ne D�Operryin 9uettion:
' � O — ❑ Reai property � MnwOy essessed rtnWe hwne (IC 61.7-7)
It anY portion W Ne retiAential s4umre or Ihe IaM nol exceeQOq ana (7 ) aae that imme0iately wrtound9 Nat stnrc�2ls used b proCUre incame. desrnbe Ne use and pwtion
ot Ne property uC�ieO b pioAUte "uKOrtre.
� :�6-ia-/g_ roa,00a. s�8-o�b'
-.� . .: . .
Caunty ' Twmship County Towfahip
1 hereby cerlify the above stsiements are We, correct and complete. Signature o1 daima �
Address � arH sbeet dN. afa . a ) �+, �x/ �
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Land not exceeding t(one) aue Immediatety ��>r"� ��=�'`����-rn�^"'-
surroundi resitlential im rovemen�. �» }'�i^-����'�'a-. � �?%y
ONer IanC (2) ������:
7otal land (fine 1 plus line � (3) �
l;i.cy�.;,,n. S �,s:,�J.�s�..�+�� e�.--
ResldenUal improvemenis or Mnualty �����9 �4) �'�"�"��S'�x r
.�t[� Y \f-4 'x'SS4�TC�wt3- :�
Assessed Mobib / Manufacwred Home Gare e 5 ��� :.-��� ��`,�r,�,� �� x�
9 � ) f�:x.. -,Xe. . w�v..s..#`_+�, •
Other improvements (6) '?��� �'���=`5
X� .5` �'! � ,�:
7ota1 Improvemen6 (l7ne I NrougA line � (7)
iotal value (flrre 3 pl�c line 7) (8)
1 here6y certiy the above is true, wrtect, Sgriawre of Assessar Date signetl (mmth, day, yea�
and complele.
VeriN��9 adion - Si9�Nre of t�udiw Date signed (rtronth. EaY. Y��
� . - � � � • •
� 20 pay 20 _ Lesser o( 60% of the assessed value of ihe homestead or $45,000 __.
NotwifhstaMing eny olherpro�islon. Ne sumW Ne detlurl.�wu protidetl in IC &1. f-11 to e mobde l+ome Nef is $
rpt essasasa es real propeny w to e menutarlured /rortie Nat'a not essassed as real property may rwt axceed -
onefiaH(121 W Ihe esusseO velue d Ne mo6de fwme a mantAadured frome. -
Signature at PuEttor Date signed (mmth, daY. Y�A
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