Homestead_ZinkCLAIM FOR HOMESTEAD PROPER p1 ,�
: _R• ? STANDARD / SUPPLEMENTAL DEDUC O �. �'
� State Form 5473 (R72 / 609)
s. P�;� � we �m o� �� ���m F�� DEC 1
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2��2
FORM
HC70
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INSTRUCT70NS: Sae reverse side forhliig inshucfions C,',.n� �-1 V .
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I(We)' °E� G�B � certiry that I(we) ocwpied as my (our) prindpal
place of residence or m(are) buying the following described real property for ich a Homestead Property Tax Standard Dedudion is hereby daimed
under conVact on the data this appliration is filed, (date o/lling):
�� (we) own ❑ Am (are) buying under recorded convact . ,
Fvn (are) entiUed to occupy as a tenant-stockholder of a cooperalrve housing corporation
� Have a benefidal interest in the Wst or the right to occupy the property under the terms of a quali(ed personal residence Wst
�. .. �
Name of dauriam (kgal �rtre)
SocalSequitY dgis) Dm�ers Ocense I Identifitation / Other
Name ol da' n s spouse (legal name)
S e �
SoUal Seauiry
� .
• ••� �
If Wying m mntrarx Fee Simple amers rume
Recoiders office where conGIDG is iem�de0 Recard num6er Pape
..�• ' � • •
Counry Tamshi7 � Ta�+B d�a � row^sMP .
Parcd �wmber �e9al OesaiPtion I Ne P�P�Y in question:
' eal property ❑ AnnuaOy assessed moh'le home (IC Gf. f-7)
If any portion N Ne 2sidential strucNre a Ne WM not ezcee0'ug one (1) aoe iha[ rtnmediatety s that sbucGire is used to pmCUce uicortie, EesrnDe tfre use and por0on
a, ma wopem uti�ea m woo�ce Nm�rre.
� 6-�5 ��- ac� ca� �355 G, � �
... . . : . .
Courrty Township Counry ' Tovmship
I hereby certiTy the above statements are We, corted and complete. 5 retu o i t , �
Address (num6er aM sbeet, city, slete, aM ZIPCO�e
ic- L 7
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Land not ezceeding 1(one) acre immediatety �� "���'y"r '�'d�'- "�� p`�'" 'n%��
8urtoundin Rsldenlial im rovemen5. ' (» �.��T`��"�^-��`�`�'� �?� �
4
Other land (2) ��,�'�e>,.���:
ToUI land (line 1 O�us fine Z) (3)
`" '�v;�`�-;� "� �`rt �
ResldentialimprovemenborMnualty �Ilin9 (4) ���.m,�.�rs�x� i,?+F��:
0.uessed Mohik / Manufactured Home Gara e "��'�w� {� �`' "-�?��7+."y��r:z
A (5) :i>r?%.1'�au .'.�'���.,.,_�. � fa�5'a2:�kR..�;,
7.��:: _.+s',.`�.,,s:' .
Other Improvemenb (6) '.�},'-,'n;�•�sa�g.,t.,r
7odl Improvemen6 (line 0 NrougA line � (7)
Total value (line7 al�a line � (9)
I hereby certity the above is We, cortect, SigruNre afASUSSOr Da1e signed (mw+M. daY• iTaA
and wmplete.
veiN��9 action - SyriaW�e otfWNta Date signed (rtmnM, daY. Y��
� . - � � � • •
20 pay 20 Lesser of 60% of the assessed value of �he homestead or $45,000
NWwCASfard'ag anY otherpiova�br�, Ne sum o/the dedWions provided in IC b1.7-72 to a rtrob�e fame Nat (s $ '
not essessed es real propeily a lo e menufactured hwne Ne( is raI essessed es real poperty maY rpf esrced
mehaG (1R1 d Na essescetl vehmW fhe niobde home ormenuFaCUred hane.
g��aW�{p�i� � — Dace si-97rretl (month. dzY•Y�
( v � % � % c /OC —� % —