Homestead_Sutter"'" CLAIM FOR HOMESTEAD PROPERTY TAX
i_.. '� ST DARD / SUPPLEMENTAL DEDUCTION
S e Form Sd73 (R12 / 6-09)
� 25cnbed by the Department of Locel Govemment FriarKe
INSTRUCTIONS: See raverse side lor filing ins(ruc(ions.
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APR 6 2U1U
I(We) certify ihat I(we) �ed as
place o esidence or am (are) buying the following described real propeny tor which a Homestead Property T1ill�aA�F��oii i
under conVact on Ne date this applintion is filed, (date of filing):
❑ � M'e) am ❑ Am (are) buying under recorded contract
❑ Am (are) entltled ro omupy as a[enanbstockholder of a cooperalive housing corpora[ion
� Have a beneficial interest in ihe Wst or the right to occupy the property under the terms of a qualified personal residence Wst
Namao(
Sotial Securiry numbelof tla'unani's spouse (las
It buying om m�tract, Fee Simple ownets name
RecoNefs of&r where mniract is recorde0
Counry R
Drners ficense / IEentiS�al
of tlaimant (/est five digrLS)
ot daimam's spouse (Ias1 frve dlgits)
Taring
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RemN number Page
(cifY. mwn. rou+ishi0)
ParcrJ number Legal tlescnpGon Is Ihe proOU�Y � Vuestion:
/.�6T5 ! 7 9 ij�BO �R�i ��,ty ❑ Annuauy assessetl mobile home (IC Gf.f-
U arry portion ot tne resiAential swcwre or iha IaM trot exceedug me (1) aae that immediatery surmufWs that swc¢�re is usetl m produce irromne, desaiCe the use aM poroon
of Ihe ryoperty ucSa� to protlufe inmme.
,26-/l-/d-/o3-000, 33/-Oa�
Counry
TownShip
I hereby certify the above sta[emenu are we, correct and complete.
Address (numDer arM stleet, ary,
1 9?>9, ��l
LanA nm ezceeding 1(one) acre immediauty
Other land
Total land (line 1 plus line 2)
Resitlentlal improvements or Mnuaity �����9
Assessed Mobile I Manu(actured Home Garzge
Other improvemenb
Tatai Improvemenb (Ilne 4 fhrough line 6j
Total value (Ilne7 pLa llne �
I hereby certify the above is [rue, cortecl,
and complete.
Verifyi� action - Signawra of N�ditnr
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i2)
(3)
(4)
(5)
(6)
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SigreNre af Assessar
Caunry
20 pay 20 _ Lesser of 60% ot the assessed vatue of lhe homestead or 545,000
NoRViNSlandvg eny Wha�pmvisun, ihe wm d the tletluclions pmvided in IC E7. f-f 2 to a mo6�e home Nar b
nat assessed as real properry or fo a menNarlured hwne Naf is not essessed as real pmperty may not erreetl
ru�mhaH/f/JI N Me wssessed velue o/ Ne rtnbde home ormanulaUUred /rome.
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Township
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Date signed (rtronth. daY. YBaA
Date 5igne0 (monN, tlay, yEa�