Homestead_Greene (5).�
t/
�
"'" CLAIM FOR HOMESTEAD PROPERTY TAX
� STANDARD / SUPPLEMENTAL DEDUCTION
� v State Fortn SG73 (R12 / 6-09)
S � Presaibed by ihe Departrtrenl M Laal Govammem Fna�e
F�I F
�APR 18 2011
YEAR
IIYJ / RUIi / I VIYJ: JCtl !d Wl3C SIOtl 10( IIIIINf Il13lN41N05.
c.'J.n
. .
� �e) . . GIB���Y��1 ��� my (our) prindpal
place of residence or am (are) buyi�g Ihe following desaibed real property (or which a Homestead Pmperty Tax Standard Deduction is hereby daimed
undu conVad on ihe date ihis appiiralion is filed, (dafe o/filing):
❑ I(We) own ❑ Am (are) buying under reCOrded conVSd
❑ Am (are) entilled lo occupy as a tenant-stockholder of a cooperetive housing corporation
� Have a benefidal interesi in the Wst or the right to occupy Ne property under the tertns of a qualified personal residence Wst
•- . .
Name of qa' nt legal nartreJ ^ � .
1
Sodal o( �hnant (HSt fne G9.�S) ��ce(� l� �� � � Iswmg State ��
.
Sodal Sewriry number of ciaiman['s spouse (W9 five dgrts) Drivers license I Identification I Other number Iswing 9a's
' W daimant's spouse (last (rve dqits) ' '
• ••� �
If buying on contrstl. Fre Simple ownefs name �
RecoNefs oi6ce where mnVact is recrn0ea Reard number Pa9e
..�. . � . �
� II_^ � Township Ta�cng tlistrict (Uy, to t I ip
✓ ���
�J�LJ
grcd nu ber Leqal EesaipGm Is Ihe WoPenY in qu�tion:
�P— ��—U� — ci- i��m ❑ MnuaDy assessed moCiie home (IC Sf.1-7)
It any po�tiai of Ne regdentlal swcWre or Ne IarM nol exceeding me (1) aoe thal imrtrediatety surtou s t strucwre a used to produca Incoma, desrnba Ne use and portion
oi me wo�m w�e m�e�e inca�e.
-.- . � : . .
Caunry Township Couniy Trnvr�Aip
\
I hereby certify ihe above ststements are We, corteG and compiete. g`��� � �
Ereu(num�raMSVeet. - '.urqZ/P/_c`qde)
l T >1 � �� � 7�t7�
•• •
� • . � • �
�i . �
LanO not exceedi�g t(one) aae Immediately �; W �'y.�-"�'f".� *��
surtoundin residentialim rovements. (�) ��3 r'.�3"g"'Q�-iu �--�'�.�E%'`�-�W
Other land (2) �+��,t���``t°,-,-.,;����z� .
.�+.+;_. y' '
Tofal Wnd (line 1 plus line � (3)
� � '�:v�+Y� � Y.
ReeidenuallmprovemenborMnuatty �I���g (4) ^`' `�``��'�;�`�"�` �
�� w`�'`ti^ >
Pssessed Mobik I ManuFacwred Home 9 �5) �� za�� �.-`•'r"� s�.?�1 ��sR`�4;
Gara e � 4'���a� .,ai �'�+c",�"��a��'�a''�'•-'S'.
.���?�'�3'.p.',xtY<';�':cb �s^�
Other improveme1rts . (6) .'y-`3?;5'�S''°iSriY?".�+.*_
Total improvemenh (/Ine 0 Nrough line � n)
Total value (line 3 pl�s Ilne 7) (8)
I hereby certify ihe above is We, wrtect, Sigriawra of Assessor . Oate signea (month, day, yoa�
and wmplete.
Vailyirnj action - 59naNra of Audtor Date vgned (rtron(�. daY.Y��
�.-� � � � �
20 _ pay 20 Lesser of 60% of the assessed value of lhe homestead or 545,000
NoMithsfaMrtg any atlmrprovision. Ne swn o1Ne Eedurlions povide0 in IC 61./-12 to e mabRe fartre Ihaf ic S
not assesse0 as real property w ro a rtanNact�red home Nef is rof essessed as real property may rwt ei'ceea
o tl(12fdNe ssessed W�hemobdehomewmanuhCUiedhwrie. �
f Date yy�eC ( —. Q27S yea
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