Homestead_Yancy♦ t
�'"'" � CLAIM FOR HOMESTEAD PROPERTY TAX
;�ANDARD / SUPPLEMENTAL DEDUCTION
S te Fortn 5473 (R72 / 6-09)
�` 1 reuribed by the Depanment of Laal Govemment Fraxe
INSTRUCTIONS: See raverse side /or filing instructions.
� ��
FORM YEAR
HC70
e2�l�i_/b
I(We) ` - T'1-�+ cerliry Nat 1(we) occupied as my (our) prindpai
place ot residence or am (are) buyinq the following described real property which a Ho tead Property Tax Stan�eductjqn jsrhere6y tlaimed
under mnVact on Ne date ihis applica6on is filed, (dafe o!filin �� '�' �'� ��
9)
❑ I(VJe) own ❑!vn (are) buying under recorded contract CalB$ON COUNTY AUDITOR
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing wrporation
� Have a benefidal interest in Ne wst or the right ro occupy the property under ihe terms ot a qualified personal residence Wst
Name
� spouse (lav
If buying om m�Sap, Fee Simple ovmers rume
Reoortlef5 atfice where mntraa is recarEed
Counry
umer'S ucense / Itlnntifrcalion /
Drivefs tirense I ICentificalion / ONE
of daimant's spmise (lasl frve d/
any pa ihe residential sWdure w ihe IaM nw exreedtrg me (1) acre Nat imm
't�e O�o utifaed to produca inmme.
c�G-/a-��-�a-aoa. 4�a--oa8
Caunry
Trnmship
I hereby certify the above statements are we, cortect and complete.
slafe, ard LP tode)
:�Ifll/ �'f
Land not ezceeding 1(one) acrc immediatety
surtounding resi0ential improvements.
Other land
Total land (line 1 plus line 2)
Residentlal impmvemen5 or Annually �����9
Assessed Mobile 1 Manufactured Home Garage
Other impmvements
Total improvements (Ilne 4 fhroug� line �
Total value (llne 9 phs lina �
I here6y certiy the above is trve, cortect,
and complece.
✓eifying acfim - SignaNre of /wtlimr
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(3)
(4)
(5)
(6)
a)
(8)
Sigratu2 of Assrssor
Tating
Issuing
Remrd numDer � Page
rown,
Is Ne P�P�Y in 9urstian:
� Real pmperry � AnnuaOy assessed mobile home (/C 61.7-:
n Ihat sWCiure is useC m pratlure i�ane, Oesvibe Ne use aM portion
of
20 pay 20 _ Lesser of 60% of the assessed vAue of Ne homestead or $45,000
Noluiflufarrling any otherprovivon, Ne sum of lhe tletluclioru protMetl in IC E7.1-f2 to a nabDe home lhaf k
mt assessed as real property w to a manufaaured hame Ne( a rrof essessed as reel properry may rot ermed
S
�9g��t555
Tavnsltip
Date signeE (monN. daY Y��)
Sgriature of iWEI[w I Daie signed (monN, tlay,
Y