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�. CLAIM FOR HOMESTEAD PROPERTY TAX
rt• A STANDARD / SUPPLEMENTAL DEDUCTION
S State Form 5473 (R121609J
�O 1 PresGibeO M Ne DeGaMre�rt o1 Loml GovemmeM Frmxa
INSTRUCilONS: See reverse side for filing inshuctbns.
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SEP 6 ,o
C .'J. f(b�Y� :. .
YEAR
I(V✓e) _n (° 'f' 111 U f\ l J. J C 11 Q-T Z certity Nat I(we) ocwpied as my (our) prindpal
place of residence or am (are) buying ihe following described real propery /or which a Homestead Property Tax Standard Deduction is hereby daimed
under conVact on Ihe date this appliration is filed, (tlate of filing): � ��
I(We) own ❑ Am (are) buying under recorded coniract
Am (are) enliLed to ocwpy as a tenanFStockholder of a coaperative housing corporalion -
� Have a beneficial interest in the Wst or the right to occupy the property u�er the tertns of a quaiified pereonal residence Wst
Nazne ot deunem (kgal name)
�-4 a r m a n
�� �� � ����<<�� �
Name �
S c. il q fi Z
of tlaimani (Ws( frve
sw�+-s (�u n�re e;qrx.l I o�rs noo,,e i ia�er,��a, i a.ner
w aa��rs sPOUSe ��a� r� dy��
11 buymg am m�traq Fee Simpk owneh rame
RecorEers otfice where mnVact is recoNeE
Counry
IuN.
��� �ti.
Remrd numCer � Page
ParW number Legal desaiption Is ihe property in Qu�tion:
'�- .� I � 0�7enY ❑ MnuaOy assessM rtnb0e hm�e GC b�. f-;
tt any poRion of ttre msideniial smnL�re or Ne W W not exceed4ig me (1) aae �hat 6nmedWtety surtountls Nat sN�cWre is used to produce 4imme, desm'be Ifre use and portion
� a� ma wovem u57aea m v�oeuce inmi,re. . . . ,
a�-ia-��-ioa-�a. io�-oa�-
Caunry
Township
I hereby certiTy the above sfatements are We, corred and complete.
Address (num0er aM sveet. ury, state. and Z!P code)
Land not e:ceeding 1(ane) acre
Olher lantl
ToUI land (line f plus line 3)
ResidenUal
0.ssessetl N
Owellin9
Garege
Other improvemems
Toql Improvemen5 (flne 1 through Ilne �
Toql value (line ] pl,s line 7)
I hereby certify the above is true, corten,
and tomplete.
VHi()'II19 8C11M - S191NWR O(�t0f
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�2)
(3)
(4)
(5)
(6)
�)
le)
Counry
2D _ pay 20 Lesser of 60 � oi ihe assessed value o� Ne homestead or $45,000
NoMT(hsfaMirg any other provision, Ne sum o/!he detlurlions p�oriCetl in IC G7.1-12 to a mobde frortie Naf is
ral essessed as real praperty w ro a menWerlured hwrie Nat @ nd esseuetl es real p�operty may rror exceed
one�heNl1R) dffre assessetl vdue a/Ne mo6de home w manuFarlured Irortie.
S
Townstdp
Date signed (mortM. daY.1�+)
signeE (rtronth. daY. Y��
E (rtx�(h, day,
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