Homestead_Binhack (6)'v /
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTAL DEDUCTION
$taU Form 5473 (R72 / 6-09)
Prescnbetl by �ha DepartmeM of Laai Gavemnent Fre�xe
FORM
HC70
_I
/N57RUG llONS: See leversB Sitla tW N/r1g mSfNtflOnS. -
. �
I(We) Nry that I(we) occupied as my (our) prindpal
place of residence or am are) buying ihe following described I property for which a Homestead Pmperty Tax St��d ���'� here6y daimed
under mntract on the date this appliption is filed, (date o/filing): .
❑ I(We) own � ❑ Am (are) buying under recorded contract � n/ .
❑ Am (are) enlitled to occupy as a tenant-stockholder of a cooperative housing corporetion i��
� Have a benefidal interest in the Wst or the nght to occupy the pmperty under the terms of a qualit�d��a�r�Iel�F,e�'trAdJDITOR
•• . •
Na e t d2iment (kgal mB) ` '
So�l Srnuity
Name oi da'v'ant's sparse ( el na
SodalSecuriry
� ••� �
tl buying om m��ct, Fee SImD�e ownUs reme
Remrdets offire w�eie mntreG is iecoNeO Record number Page
..�. . � . �
Counry TwmslilP T' '(rily fown. townshiP)
Paicel number L I tlesaiP� [ ^� � G is me p�openy in Question:
' S �(J � J- O� ' i( Real pmperty ❑ MnuaAy assessed mobile hwne (IC 6f./-n
tt any portion d Ne rPSitlenilal sw�wre a Ne land not exceedhg one (1) acre lhat immetliateJy wrtauntls ihat sWmra is useG to produce 4�cane, Eesmbe the use and portion
of Na ProPeM uUf¢etl N P�uce inmme.
al -1/-a5-3oo_ 000. �59-oa7
-.. . , : . .
Counry Township Caunry � Trnmsttip
I hereby certify the above stetements are We, corteG and complele. Sgnaw of daimem ' �
AGdress(numCerand �f,a(y,s(ate Poode)� ��
�.
� � . � • �
•• �
i�'. •
Land not e:ceeding 1(one) acre Immediatey `�`'�- v���'b�'�.s'rr���r �
surtoundin resldentialim rovements. ��) -�.�-��� -.�h"=�??� -�'�'�l>�-�"—«
F C5�': '"i°f
Other land (2) !;a-". `vtiu��:' '
Total land (line 1 plusline � (3)
Dwelling (4) ����'s'�,i.�'' '��4+; �
Resitlenllal Improvemenb or Mnualty � '`�� "��
Assessed Mohik I Manufactured Home ���{E,s �"�T''�'��'` X. ��
Garege (5) l� �'3�Y1'��".�.�-��#� z'z
��• � L�OSiS�' vxs :
Other improvemenb � (6) ��,;,,a� ryy�
Total improvemen6 (Ilne 0 NrougAline 6j (7) �
7otal valua (llne 3 pl�s line 7) (8)
I hereby certiy tha above is We, wrtect, SigriaNre of Assessor . Dare signed (rtronlh, day, yea�
and complete. '
Vaitying action - SignaWre W Audtw Date signM (monN, day, year)
�.-� • � � •
20 pay 20 _ Lesser of 60% of the assessed value of lhe homestead or $45,000 .
NWudNStandNg any oUrer provision. Ne swn W fhe dedcrtbns provided in IC 6f.1-72 to e moM7e fame Natls $ �
not essessed as ieal property w!o a manulacluretl home fhat is rwt asseued as reel properry may rwf erceed
ono-haH (72) d Ne assessed vafue N Ne mobie home or manufarfured home. �
5' naW of Pudltw • Dafe sipned (month, daY. Y��)
9
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