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"'" CLAIM FOR HOMESTEAD PROPERTY TAX
i._. : STANDARD/SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R72 / 6-09)
�'' � Prewibed by the Departmenl ol Local Goverrvnent Fnance
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ina r nuc uuns see reverse sroe ror muig msnucuons. �^� � zU1 �
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I(VJe) � ceAiTy that I(we) ocwpied y r) prindpal
place o( residence or am (are) buying the Ilowing described real property tor which a Homesiead Pmperty TasGIBSON G V UN i T!�� �m�
under conUaG on Ihe date this applin6on is filetl, (date o/filing):
❑ I(We) own ❑ Am (are) buying under recorded contract � .
❑ Am (are) entltled to ocwpy as a tenant-stockholder of a cooperaGve housing corpora6on
� Have a beneficial interest in Ne Wsl or the right lo occupy the property under the tertns of a qualified personal residence Wst
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Name of da'unant (hgalna `/
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Sadal Senuity nm8c d dae�ant (!aC fie d'gE) Oriv�s I Identi:
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Name af damuni' spouse (lepal )
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Sodal umDef of Uai nYs spouse five tligrts) Orivers / Identifxation / ONer mimbet Issuing
�� w a�,am�s sw�� (wu r� d,�as� �,
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II Wrying m mntracc, Fee Slmple ownefs rama
Reoordefs of&i where mnhaG is remrdeE � Remrd number Page
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Counry ` Ta.mshiD Ta�mig distri '. fown. iP)
ON
Parcal number ' � �7� I Ue p qurstion:
p���' a Realpmperty AnnuauyassessedmoWehane(IC6f.f-7)
II rtia� U Ue rasidential sVUCWre or Ne la'W nol exceeding are (1 � aae ihat 6nme�:ately,5yqou ds �hat sWdufa is used to pmduce inoome, Gesrnbe ihe use antl ponion
oi m wo�m �wa�a m�a� m��. • �L� ff��
�G_ i� �a- � - �a��-o�..�
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Counry Township Couniy , Tmmship
I hereby certiy the above stetements are we, cortect and complete. Signacure o1� .
AAAreu (number and sfreet, tiry, slete, an0 LPCOOe)
^ I� –7�'TJ w cr..,EC _ v�- — J�- y7 � .
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LanA not exceeding 1(one) acre Immetllately � �F�t�>�� ���,���–. ���Y
surtoundin residential im rovements. � � �
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Olher land (2) ;.�,�����'y;_
Total land (line 1 plus line i) (3)
; _�g,'7 "�'��-i".F R'£r'?s� "`�'�
ResidenUal impmvemenb or Mnualty �����9 (4) "T' `�`'f �'sF�"r r�'� �"�
Aasessed Mobik I Manufac4ired Home � 5'� �'y�'� �s"'�'*�it`#`�=?'t._�
Garege (5) ��''^F' � x'"r=r,.2..in.f,�."�.a�.3.a,�
1 �= f � f-
Other ImProvemefns is) w�,�`'�',.��ss��w''s' �"
Total improvemenb (llne 1 Nrough llna � (7)
Total value (llrre 3 plus llne � (8)
I hereby eertify ihe above is We, cortect, S�"a� °��� ' ��'� (mO��' �y ��
and wmplete. •
Vatlyutg attion - S5�Nte o1 PuditOr Da�e signed (rmnM. daY.Y��
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20 pay 20 _ Lesser of 60% of the assessed vAue of Ne tmmestead or 545,000
NWxifAS7anding enY otherpiovision, Rre sum W the deduc(kvu pro�+dM in IC 6f. f-72 fa a rtmAde frome fiat is $
nof essesxed es real property a to e menufecfured hortie Uu( @ nal essessed as real property maY �t exceed . '
oneJ�aH (1/I) W Ne assessad vehre W Ne rtabde homa wmanWacfured harie.
59riaLUe ol Pudttw Date signeE (monlh. daY. YTa�