Homestead_Stewart (6)�
CLAIM FOR HOMESTEAD PROPERTY� vena
FORM
i, _. ., STANDARD / SUPPLEMENTAL DEDUCTION Hc�o
Stata Fortn 5473 (R72 / 609) �/���� P�
�O � Prewi�ed by Ihe DepaMeM of Loml Govammerit Frmnca �+ � w�V� � \
INSTRUCTIONS: See reverse side /orfililg insfrucfions. - P'� ��
11
I(VJe) � certify that I`twe) occupi s y(our) prindpal
place ot residence or am (are) buying the following descri real property for which a Homestead Property Tax Sta�da$t i reby daimed
,u�ntle�r a on the date ihis application is filed, (date o!filing): pUp1T�R
��J�f (We) own ❑ Am (are) buying under recorded conVact G1g5�p CO�N�Y
❑ Mn (are) entitled to ocwpy as a tenant-stockholder of a cooperative housing corporation
� Have a beneficial interesc in the wst or the right to occupy the property u�er ihe tertns of a qualified personal residence Wst
name)
Sotlal Seauiry numbu of daimafrt's spouse (lastlrve dry
If buying on contrac4 Fee Simple owners name
Recortlefs ofike where mntraG is remrde0
Counry Taunship
Parcd tw Legal tles
— w� '�`' e�
� of Ne � d NWT¢ed N produre'mcome. Ure Wrd no�
Counry
Tovmship
af daimant (lasf frva dig'
I'� �
Reard number � Page
G�siria (r�N• fm++�, townshiP)
Is Ne V�Pe�Y ui que57ion:
I LI � wnaertr LI AnnuaOy assessetl modle home (IC 67. f-n
orre (7) aae Nat muneaiatey surrowMs ihai strucwra is usad m pmduce 4xome, desmbe the use aM pwtlon
� � 1 � � � � �
I hereby certify the above ste[ements are We, cortecl and complele.
PdAress (numDer and sheef, fily, state, antl ZlPOOtle)
Land
acre immediatey I ��)
mvements.
Ofherland
Total Wnd (line 1 plusline � �
Resldentlal improvements or Mnualty �����9
Assessed Mobile / Manufactured Home Garage
Other ImprovemeMs
Tofal Improvemen� (line 4 Nro�gA fine 6�
Tofal value (Ilne 3 pllc line �
I hereby certify Ufe above is We, cortect,
and tomplete.
Veifying a�ion - Signature oi PLtlitw
(4)
(5)
(6)
Cwnry
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
NoM9(xWrd'ag eny aher piovisbn, Ihe sumW Ne tlMUCfiwis proyided in IC 6f. f-12 4 a rtnbde hortie Nat is $
I/Oi 655BSSCl/ ffi/B8� PlOPBi}�Cl i0 8 TBIW(8fJ11/Bd �IORIB f/18f 6 llOi BSSB558f/ BS TR� plOpBll}� /ll8y' /10f B%LBBf�
Township
Date signed (monfi� daY. Y��)
Dale signed (monN, day, yea�
�8i8 SI�IItd �RILVIUI. Qdy