Homestead_Adams (2)CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R13112 -09)
yw ! Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See raverrse side for filing instructions.
. 0
� I
?•.'s:.r.�i'%:?'.%� =?-. �Zinmi+.kiY}.ai= �.Y.'''43b'`, aCERTIF,.ICA710N STATEMENTs:.'is + r(Y JS�"ia'2..1ax+[zr "?tc? '�i'�'"°'_
I (we) I.,certity that I (Cmi (our) principal
place mby claimed
= ;.., •.O
.:Own Am (are) buying under recorded contract
cooperative
■
■ Am (are) the shareholder, partner or member of the entity that owns the property.
T.r. �... {L '�- 5..
3sC; t-. R�ct; z^ isf:. b�'...:' a. etscz" ut-' ""#•CLAIMANT'S�INF,ORMATION;ti.. ::? :. fi��.:.tr
i J }•�
P.R6FERTYf)E00P.TIONzk�M$1&S�:.:..tr..,lr*- ,"czapi�`.•w..
T township)
KNE
LJV
FS;a' PRORT. IVOWg-I ED 'BY;CL AI
P, E
MAN7IN.' OTHER'000NTIESt
I hereby certify the above statements are true, correct and complete.
iiii nu t street, city. Vote. and ZIP code)
�, � -Sf .x: � v>nv e F r�-t L •+�sr t�> a ,r 3io3'��( .ASSESSED VALUE; ^5'HOMESTEAD $'�.1 NON - RESIDENTIAL ,.s -`4'
K. -' 2fi ,,ASSESSOR USE ONLYa S:xn .., I�drTRU�T! 2ATS100- �c:V --�r . i- .�,i1't .: VAL'UE. e , T 2.
1'.
Total impsivernent3 (fine 4 through line 6)
Total value (line 3 plus fine 7)
and complete.
J III
.r
ARN_DEDUCTION�P.LLOWANCE:
20 pay 20 t .11
NoSwilistending any other pinvivan, the sum of the deductions provided in IC fi- 1. 1-12 to a mobae homc,
not assessed! as real property or to a manufactured home that is not assessed as Mal rimperty My not a
on�haff (V2) of de assessed value of the mottle home or manufactured home.
Date signed (incilth. day, year)