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"'" CLAIM FOR HOMESTEAD PROPERTY TAX �
_ ?; STANDARD / SUPPLEMENTAL DEDUCTION
S State Fo�m 5473 (R72 / 6-09)
° � Prewibed by the DepaNrent of Loml Govemmerd Frmxe `�
FORM YEAR
H 0
ina i rtw nvrva aae ravarsa sma ror mng msnucrrons MAY 9 20
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I(We) certify that I(we) i s my (our) prindpal
place of residence or am (are) buying the fo Iowinq describ real properry for which a Homestead Pro�`1$�i Rpt�� DY u is hereby daimed
und conUact on the date lhis applicalion is filed, (date of fiirrn�): T AUDITOR
I(We) own ❑ Am (are) buying under recorded conVact
❑ Am (are) entltled lo occupy as a tenanFStxkholder of a cooperative housing corporation
� Have a benefidal interesi in Ihe wst or the right to occupy the pmperty under the terms ot a qualified personal residence Wst
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Name of daimant (legal name) '
nartre)
Sodal Seauiry rnimbel o� daimanYs spousa (last (rve d'gIIS) Drivers �icense / Identi`ration / Olher number ' Iswing Sa's
of tlaima�rt's spouse (last frve dpiGS)
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iFb�eaeSTee Simple awnefs �ma
Recordefs of6ce where wnUac7 is recordeE Recard numbu Page
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Caunry .. 7amship � Tadng d'atria (dty, rown. [ownshi0)
a,r,c(q'j]n r Legal desai ' Is Ne pmperly in question:
I�/ - D- D• 1 b� ❑ Rea� PmPeny ❑ NinuaOy assessed mod'le home (IC 61.1-7)
If arry portion d Ne tial stn�re w Ne IafW not ezceedi� rne (7 ) ave tha[ immedWtely surtouMS Ihat strucW`e Is used to yodure Inmme, desaibe Ue use and portbn
' at tl�e pmparty uoTited to G�uce inwma. �
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CouMy Township Counry � Township
I hereby certify tlie above s�stements ara We, mrtect and complete. Signature o1 nt
tess num ntl aveeS �l: sta7e. and Z code)
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land not e:ceetling 7(one) acre immediatety a'p.� �'�'?�-"''�`-'��"`x° � ��."�-
surtoundi residen6alim rovements. (�) �s".�:�`'���'3'�:��'-3_•yt�"�
f�'t:. �y. :. -., .
ONer land (2) : rEi���v-��: .
Total land (line 1 plus line � (3) •
Dwellin ;�'• �r�' � x'
ResidenUalimprovementsorMnually 9 (4) _'��`"�:� ��.�,r� t�y�.�,�
Aasessed Mobik 1 ManuFacCnetl Home .*"%>'gc:�-§,^-�'� a�.r�.'�� '`�µ �-'
Garag¢ (5) ss'�r,:.i 51..�_:`.�n� r:u�%S;#`?�°.
Other improveme�rts (6) � K h'-� ��
;�zr.`Pt�'%�'. a�
!�k.'.Y'�1�.';�:r: �TT�
7otal imD��emenb (Iine I lhrough Ilne 6j (7)
Total vatue (line7 pl,a line 7) (8)
I hereby certiy the above is We, cortect, Signature atASSe_ssor � Dara signed (month, day, yean
and wmplete.
�e�`P�9 ad'pn - Sig�uWre of AuNtn . Date sic�u-0 (nanM. OaY. Y��
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20 pay 20 _ Lesser of 60% of Ne assn_ssed value ot Ne homestead or 545,000
NofwifAsfaMirg any Wherprouisiwn. Ne sum o/fhe dedurliwa pron'ded in IC 61.1-f2 to a mob�le home Na� ic S
rot es.sessed as �eal property a fo a menu/actured harre Nat "s rot essessed as real properry may not exc�eed -- ��
rne-heH(12� oI the esussed value ol Ne mobi/e hame w manulactuBd home.
SigriaWra of hditnr Date a9�� (monN. OaY. Y��