Homestead_Taylor (10)d CLAIM FOR HOMESTEAD PROPERTY TAX
�._^ ? STANDARD / SUPPLEMENTAL DEDUCTION
State Fo�m 5473 (R7216-09)
•� •° Prescribed by the Departmant of Local Govemment Firiance
INSTRUCTIONS: See �everse side for filirg inst�uctions.
1"N
� OR YEAR
HC10 .
SEP 1 1 2009
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��
I(We) cenrt�sify� inha�t I�( ^�. pi yspy lour) pri�pal
place of resid ce or am (are) buying the follovnng described real prop y for which a Homestead Propanyrea tlJttl Deduc w��ls�iereby daimed
under conVa on the date ihis application is filed, (date of filing):
❑ I(We) own ❑ Am (are) buying under recorded contract
❑ Am (are) entiUed to occupy as a tenant-stockholder ot a cooperative housing corporetlon
� Have a benefidal interest in Ne Wst or the right to occupy Ne pmperty under Ne tertns of a qualifled personal residence Wst
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IJ e fdaiman al am )
Sodal rity nurMer
�� o( nt (lasf frve tlyrts) /� /
Name of daimant's spouse (le9a ame)
ecuriry (lasf five d'gds) Drivrfs tirertse / Itlentifcatian /
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It buying om m�UacC Fre Simple ovmets name
Recordefs oRre where tonbact is remrGed Remrd numbu Page
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�niy Township Ta�dng AisUia(city, mwn, rownship
� p'� = �^ � Legal desmi Uo- Is Ne p�a rty in queslion:
` . 5 a property ❑ MnuaOy assessetl mobile home (IC &1.1-n
�If a�ry portion ol Ne residentW stnidure or the IaM no1 ezreedirg one (i � aae �hat'unmediatey surtwnds ihat sWmre a usetl m produce i�xome, desrnGe �he use aM portion
of Ne praperty uvf¢ed m ptatluce income.
• � • � � : • •
Coumy TawnshiV Caunry 7ownship
�
I hereby ceNfy the above statemenis a2 We, cortect and complete. � ° � �
Address (wmDer antl yreef. ary, state, antl LPcade)
k%
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Land not exceeding 1 (one) acre immediatety � �7�i��s,�s���.,''�X: �y ,� � .3`,,��� =�
surtoundin residentlal im rovements. ( � "�=` �i %?^- u'-
,� ,.:� f�P%=..
Otherland (2) -t .,'_-:* F�i�_`
7otal land (line 1 plus line 2) (3)
;� .x ..�f:.ya T6.-�.�`=<
ResidentialimprovemenLSOrMnualty �Iling (4) ..::ps,. (�yr;u�M1� f.g� ,�'t
Pssessed Mobile 1 Manufactured Home Gara e ctis'= ' *�, �i� °'rY 4;��
9 (s) _>:.z�.si..r,iEit:+.r�3�'.�'.�.?Y...._......
,,,x-...,,'s_t'7:.�"'.%"�
O�her improvements (6) � ' . R'ti; rke'�
Total Improvements (line d NrougA line 6j (7)
Totai value (Itne 3 pl�s line � (B)
I hereby certify ihe above is true, correct, Sigrewre of Assessor Date signm (month, dey, year)
and complete.
Vrrifying actian - SignaNre of fWditor Date signeE (rtronlh, day, yea�
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20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
NWwiN.vaMing eny oMerprovivw�, Ihe wm d fhe ded�.rl'ans provided in IC &7.7-12 fo a mobr7e fnma /hat is g
rot assessed es real propeny w to a menuterlured home fhal is nof essessed es real pmperry mey rot erceed
onahal! (1R) W Na assessed rdlue o( Ne moD'de home or manuta�'tured home.
SignaWreolf�utlltor � Date ' ned =,Eay, r)
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