Homestead_White (11)�
"'° CLAIM FOR HOMESTEAD PROPERTY TAX
_ . STANDARD/SUPPLEMENTALDEDUCTION
i� Sfate Fwm 5473 (R72 / 6O9)
�O � P2unbed by lhe DepartmeM of Loml Govemmerrt Frence
INSTRUCiIONS: See reverse sdde /or fil'uq inshuc(ions.
FORM YEAR
�(we) \—�� (yl" Y �� V( I-7C,1 �C certiry Nat I`(wej "oca�mY (our) prindpal
place of residence or am (are) buying Ue following described real property for which a Homestead Propert�cTas �ndard �ed o i hereby daimed
under mnVact on the date Ihis a lication is filed, y�: �'�d couNrr Aupir
PD (date o7filin OR
❑ �(We) own ' ❑ Am (are) buying under recorded contraa ' �
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation
� Have a beneficial interest in the trust or Ne right to occupy the property under the terms of a qualified personai residence trust
�aoa� Je�nry numDer ot dalmanCS spouse (las
If buying m rvntraq Fee Simple awnefs �me
Recoidefs ofirx where mntraq is recorded
Counry To
Drivefsl'vxnse/loentifi�alion
ot daimant (last five d'gits)
DmeYS licenu / Identifrcalion / Olher number
ur daimanrs spa,se Peu r�ve d'gns)
Issuing State
Recwd numbr! Page
Mwn. tA� ' �
rcel number Legal OesaiP� . . Is N���e-- yyyP���roPerey in question:
b-1 a-�� - y� �vo .q i�-o a� L �yteal property ❑ MnuaAy assessed mo6ile home (IC &1.7-
tl an rtion of the residential sWCWre or Ne larid not ezceed' T
y po u�g mre (1) aue Nat immeAiatety sunwnCS Ihat sbucture is usetl lo proAUce incmie, EflSCnbe Ihe use and portion
of the P�7enY �� � P�uce inmrie.
•�• • �: • •
Caunly Tamship Caunly Twmship
I hereby certify ihe above statements are We, corteU and complete. ^a��re, �t daimant
.�^-� C lti�c,
PdOress (number and street dfy, sfate, antl LPmOe)
� ��.� . � �R�ntr �Uittripi TN. S�%GJ()
Land
Otherlantl
Total land (line 1 plus line �
acre �mmematery
rovements.
orMnuatty �����9
hned Hane Garege
Other ImprovemeMs
Total improvemen� (/!ne 4 fhrough line �
Total value (lirre 3 pl�a line 7)
1 hereby certify ihe above is true, wrtect,
and wmplete.
/edying action - Signahne of Audcw
(�)
(z)
(3)
i4)
�s>
(6)
(8)
SignaNre af Assessar
20 pay 20 Lesser of 60% of the assessed value of Ne homes[ead or $45,000
NolwiNSlaMUg any otherpm�isbn, Ne sum W(he deductions proyidetl in IC &7.1-72 ro a nrob0e fpme Nat k $
rot assessed es real properry w �o a manulactured home Nat is nof assessed as real poperty may not erteed
Date signad (rtronfh, day, yea�
bate signetl (monN, day, year�
Date V�—Vtl L �l�