Homestead_Pullum (2)CLAIM FOR HOMESTEAD PROPERTY TAX Fowm �
_ STANDARD / SUPPLEMENTAL DEDUCTION HC�o
� " Sfate Fartn 5473 (R13 / 12-09)
�„w Presaibed by Na DepaM�ent of Local Govemmem Finance
INSTRUCTIONS: See ieverse side tor fiGng insWctions.
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I (We) � . . . . . certiry that 1 ��a��pal
place of residence or am (are) buying the fdlowing desaibed real property tw which a Homestead Property Tax dard cfi n e y imed
u�der contracl on ihe date this appliration is filed, (date o(filing). I(VJe):
❑ Ovm ❑ Am (are) huying under recorded conVSCt S E P 1 4 2012
� Am (are) enlitled to occupy as a tanent-stockholder of a cooperative housing corporation
❑ Have a benefiaal interest in Ne Wst or the nght lo ocwpy the property under Ne tertns of a qualified personal res`�9denie•fnie([\— •
❑ Am (are) the shareholder, partner or member ot the entity that owns ihe property. V
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e •'� �
If buying on oontract, Fee Simple owners name
Recorders oRice where contrarl is recorded Recorti number Paqe
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Counry 7ownship T' �(ciry town, rown �)
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Partr1 number Legal description x Is the prope�ty in Question:
.ea.oc. .$o ❑ r:ra� wucenr ❑ amuaM assessce monoe nare (�c �,.,-n
If airy P�� ol the residential structure or the Wid rat exceeding one (1) aae ihat Immetliatey swrounds that struCUre's used m produce'vkome. Cesaiba the use aM putim
W Ma property uti�ed to produre Income.
d�- a3-/�_ aoo _ oo�,.$� s-o�y
-.• . .: . .
Counry Township County Taxrthip �
I hereby certfy Ne above statemenLS are We, cort'ed and camplete. °f ����
A
Adtlress (numDer eM street, ciry, state, ard LPtnAe)
c� 3 � �,J — ✓ �3 s r.� v r "— � 7Lo � 9
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Land not exceeding 7(one) acre ImmedWtely ��"3 -.�:5b t� ,�x ��' ���,
surrouna�n resmentla� �m rovementa. (1) =�=�_.-�..,'? 2:-='•-.-`,<.�- 3`
`t z .
Otherland (2) ' j _�.�,$a4Y�.-�:
7otal land (firre f plus lirre 2) (3)
Dweliln 4 - �'' L�ae ». Y �"�' `�'•�
ResidenUalfmprovemenfsorMnuafty 8 ( ) �.r, 1�e' � ��'�.. °�`s� �"
Asseased MoDtle I Manufacn�red Home Garage (5) `��� � �4�"� �`��-� s:.
.. °_ � ...
° f < . _h a 5"a3_ �
'����'n. '..5� �
Other Improvemenffi (6) � ti.�:� fr`ug,v� _.
Totel improveme� (Iine / through line � (7)
Total value (llne 3 plus Gne 7) (8)
I hereby cerdfy the above Is true, correct, �� oi nssessw Date signea (mon(h. deY i��
antl eomplete.
Veiyug adbn - SiBraWre of Audtnr Dem siBned (monN. daY• Yee�
�.•� � � • •
20 _ pay 20 _ Lesser of 60% of the assessed value ot the homestead or $45,000
NoMiMStandNg eny oMerpmvisbn. fhe sum o7 Ne deductions p�ovided in IC �1.1-12 ro a rnoWe home Nat is $
not assessetl es real popeM or ro e menWacfurad home that is nW essessed as red poperty may mt ercead
aled187 f/!10( NB eS5BS5ed rdluB Olfhe rtpWb 11olne w rtlenW2thlBd hOme.
Sigru ollviditor Date signed (month, CaY. l'��
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