Homestead_Willis (4)� t CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sta[e Fortn 5473 (R6 / 403)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side lor liling ins(iuctions.
' •�� ��
[, + � .
�(�'�e) '� �" certi at on the] da�~ Marct��20
I(We) occupied as our prin ipal place of residence the fol 'ng described real property for which a Homeste Uo�� '�' is he ��imed
❑ I(We) owned ❑ Ne buying under contract
� Have a benefidal interest in Ne entity ihat is liable for the property taxes on lhe property and that owns the property or is buying under a wntract.
If byv�g an contrecl. Fee Simpe owner's name
Recordels otfice where wniraq is recorded
County
Tonnship
Record num�er � Pa9e
��Parcel nu ber // Legal `e�n ptio Is ihe pmp�ert,-y- ,in/ question:
^ O 3 � � �' (,/ � �J �� ��� `�J� Real property ❑ Mobile Homo (I.C. 61.1-� .
I( any portion af Ne resi4enUal sW cfure w Ne land not ezceeding one (1 j acre ihal immetliatey wrrounds that slfuCUre is used la produce income, describe Na use and portbn
at ihe proDerry utilizeC tn praduce incoma.
County
Township
I hereby certify the above statements are We, coved and wmplete.
Addreu (num6erand sVeet, city, sfate, ZlPcode)
County
Signature ol claimant
. ....��''��'��'�'��-f'�m�y'�.#c`.�i�P"`"i't,''7'r'"r�i�'n.."�STANDARD,DEDUCTION'ALL'OWANCE;',: �<$��'�.3�.�6.'�S!`-`3�r�i-,�.".*. i5£'.*..��'..�rs+'+���.:�rti.,•r,� �
# .... .�c°ru , �
20_Pay20_
Lesser of 1l2 Homestead
wuaUOn or E35.000
S
Signahvaof/WdROr � Datesigned