Homestead_Wilhite (4)�
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"'" CLAIM FOR HOMESTEAD PROPERTY TAX
S ._. , STANDARD / SUPPLEMENTAL DEDUCTION
State Porm 5473 (R72I6-09)
�O � Prescnbetl by lhe DepaMrent of Ldal Govemmenl Frence
iNSrnucnoNS: s� �w� s�ae �a �r� r�sr,��s.
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APR 3 0 2012
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I(we) �i certiry that I(we) occupied a r) prindpal
place of residence or am (are) buying Ne following described real property for which a Homestead Property 7a��r�il� ��i�ibriiQ�d�imed
unEer conVacl on ihe date this appliration is filed, (date of filirrg):
�I(We) own ❑ Am (are) buying under recorded contract
Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation
� Have a beneficial inleresi in the Wst or the right to occupy the property under the tertns of a qualified personal residence wst
•• • •
Neme of tl' t Qegal nama) . /� /
L�.(.�T�
Saiel $ewrity rvurtri t(6st fi�e d J Drivels limnx I Identifxation I ONer number Issuin te
� of da'unanl(last frve d'gitsJ _/
Name of dauiwrt'
Sodal Seauiry numb� o� daimanPs spausa (last five d/gils) Drivels Gcense / IEent�alion / Oiher number Issuing State
of Uairre�rt's spouse (WSt five dgih) �
• ••� �
If buying m mntrad, Fee Slmple rnmefs �ma
RecorOers of&x where mnUad is n.mded Record numUer Page
._�. _ � . �
Counry TovmsAiP Tam+B � i�Y. [mm. (ortuh/0)
Pa�cal number /� Legal desaipt1ion Is ihe P perty in question:
� 3^ V .�;,,/ ' j� Q� � Rea� OroCenY ❑ MnuaOy a35es5etl moble home (IC Gf_ f-n
It any portion W the fesMential sWGwe or Ne W�W not exoeetli�g wx (1) arre ihat immediatety surtounds ihal smxt�re a used m poduce Imm�e, desaibe ihe use aM portion
of Ne P�PenY uSTaM W P�oEUCe urvme. �
-�• � �: • •
Counry Township Caunry Tow'ship
I hereby certity the above stetements are We, corred arM wmplete. Si natul o�daimant (� �•� , _ 1 �
K w��
PGEreu (wmber and shae .�. sfete, antl LPcod� �_�.
S .W--�
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Land not ezceeding 1(one) acre immediatety �F "'�'�,'=�.� o°�'� �T ,�'.
aunoundin resl0entialim rovemen�. ��) �+=��..�:�?���',+�:�-u'=
�cO i�3z'�U.'`'a%�C
Other lantl (2) ?�;1�.t5 _'.'.��' •�a` .
Total land (line 1 plus line � (3)
9 (4) �� �'"'����4.:.���
ResidenUallmprovementsorMnualiy ����� ""' �'��` `���` �� - �
Pssessed Mobik I ManuFacwretl Home Garege 5 ��t�'`��`�'r't'�.�'��'�'�`.9- '
( ) `:�"t}.' _s.._ .:--xw�'.�..w S�`:1.*5..,
Y :L
Other improvemertts (6) ��'i': ��� �
7otal impravemenh (Ilne d througAline � (7)
Total value (1lrre 3 pl�s Ilne � (8)
I hereby certify the above is We, cortect. �9^a�� otASSessor oate sgneC (mm1h, tlaY.Y��
and complete.
Vaifying action - Si9nature ol Pu6tn Date sR�� (����. daY. Yea)
.... . . . .
20 _ pay 20 _ Lesser of 60% of the assessed value of lhe homestead or $45,000
NofwitAstaMing eny oUrer piovisun, Ne sum d Ne deducUOns proyidN in IC 61.1-12 to a mobr7e home Nat (s �$
notessesxedasiealpopertywtoamenWeCUredhomaNetarrolassessedasrealpmperryrtwyrwterceed . - . . .
one��hall(72) d the assessed vafue d Ne mo6da home dmanufactured home.
sg�aw�e orwcrcor oace sre�� (rr+mm. ear. r�