Homestead_LathomCLAIM FOR HOMESTEAD PROPERTY TAX
S. _rt � STANDARD / SUPPLEMENTAL DEDUCTION
Siate Fortn 5473 (R72 /609)
�O l Presaibed by �Ire DeparimeM af L.oml Govemmem Fnerca
INSTRUCTiONS: See reverse side lor fifirg insVUCtions.
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1 i�"�e) // 1 WN C /\ d(!2A T L%S LY .( �1 !Y�/ ) ceNTy that I(we) occu�id �i�l(?4F) Prindpal
place of residence or am (are) buying ihe following described real propeAy tor which a Homestead Properry Tax Sfandard Dedudion is hereby daimed
under conVaG rn the date ihis applinlion is filed, (date ol filing):
❑ I(We) own ❑ Am (are) buying under recorded contrecc
❑ Am (are) entilled to occupy as a tenanFStockholder of a cooperative housing corporalion
� Have a benefldal interesi in the Wst or the right m accupy the properry urWer the tertns of a qualified personal residence Wst
oriveYS Gcerue / Itlrntlration /
of tlaimant (Ws( five d'g'RS) �
Name ol
Sodal Seauiry numbrl of UaimanYS spouse (last five
of dairtmm's spouu (WSt five dgits)
If buying on oDnVaG, Fee Simple oWners riame
RemNels oRice where oontract is recorde0
Counry Twmship
Paicel number
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tt arry ponion d Ne resitlanWl sWCW te v Ure WM nol exceed4g (1) acre that'unmeEiately sum
� of Ne P�PartY uhT¢ed N P�wx u�cartie.
a�-ii-i a- iaY- o� �..57� -oa �
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Tamship
I hereby certify ihe above stetements are we, corteG and complete.
Atldress(numDeraMStreet. sfafe,andLPCoOe)
� a�� ty r_r�r� ,
Land not ezceeding 1(o�re) acre immediately
Otherlantl
Tatal land (line 1 plus line �
ResldentlallmprovementvorAnnualty �����9
Assessed Mobiie I ManWactumd Home Garege
Other improveme�rt.s
Total Improvements (llne 0 Nroug� Iine �
Tatal value (line J plus Ilne 7)
I hereby certify the above is We, cortect,
and complet¢.
Vaifyi� aclion - Sig�ture ol Auditar
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(3)
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(5)
(6)
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(B)
SigriaGUe af Assessar
Caunry
Remrd numbu
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Page
PmP�Y in W �tion:
� Rra� PmPerty ❑ MnuaDy assessed mobile home (IC 67. f-7)
ihat structure is used m poduce inoortre. aescribe ihe use and parUOn
20 _ pay 20 _ Lesser of 60% of the assessed value of ihe homestead or $45,W0
NoMi7AslaMUg any Wherprovision, Na sum W the deticctiw�s providetl in /C G7. f-f7 m e mob�7e fprtre Nat is $
not essessed as leal poperty w to e menu/aGmed hwne Nat a not essessed as real properry may rw1 exreea
onefied (12J d Ne asseued raWe d Ne mobde home or manufaclure0lprt'e. � .
SignaWre af Pudrtw
Township
Date si9ned (rtronN, day, yea�
Date si9m.W (rtnnlh. daY. Yea�)
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