Homestead_Dike (9)° CLAIM FOR HOMESTEAD PROPERTY TAX FoRM Y�R
t CREDIT/STANDARD DEDUCTION HC�o
` Slate Fortn 5473 (RB / 7-07)
. •� Prescnbed by 1he DepartmeM of Local Govemment Financa
INSTRUCTIONS: See raverse side for fiiing ins6uctions.
� M�e) %� /—r! /J�L�� �Y' yJ� �i�.I ��% 0 � certify th�tf� tl_ � /IIIfXf March, 2b
t(We) ocwpied as our prindpal place of residence the following described real property for which a Homestead Pmperty Tac C�CiS hereby daimed:
I(We) owned ❑ Are buying under contract
Have a benefidal interest in ihe enfity Nat is liable fw the property taxes on the property and that
116vymg on coniracL Fee Simple oanets rertre
Recortlefs o/5ce whue caNaq is recortlad
Cwnry �/ Twmship T'ng d' t(cify. t
S �
ParcN number L escn ^ is Ihe pr�
� � � o� —�� I
tt airy poriion of Ihe resideinial sUVCture or the land nd e�cceedirg one (1) acre ihal immedjately wrtounds Uiat
of Ihe property uliGZ� b ptodute income. � O6 �
aG-�r-3� aoo -o���aG-aa-� �
co��y
Tavnship
I hereby certiry the alwve shatements are We, correct and complete.
(number arM shaeL cify; sfate, and LP cotlej
32 W. �1��1 Pr:r,��
Record numDar
a contract.
Page
iquesGon: �
Real ❑ Mabila Fbme (IC 6-7.1-�
ire is used to produce inmme, descnbe Ihe use and portion
,_ , . . .. . �
�� ..
LarM not exceedng 1 (orre) acre immediately . �: � . " � �
surtoundirg residential improvements. ��) ",: ��'�-' � � " -
Ottier land (2) " . �y f r -
TUaI WrM Qine 1 plus line 2) (g�
ResidentialimprovementswMnualty ����� (4) o �,�i -
Assessed Mobile / ManufacWred Home � % �; ' � .
Garage �5� n. > ,...... �{. _ . `
Ofher improvements (5) .. �
TUaI improvements (!'me 4 through Gne 6) �7�
Tctal value (line 3 phs line n (g�
I he2by tertify the above is We, corrett, end Signawre ofPSSessor Date signed (monlh, tlay, yea�
complete.
Verifying acUon - Signawre of �wr Dale signed (monN. tlay, yea�
�.-� � � • �
_ pay 20 _ qs.�pp �pr 2007 pay 2008 42.000 for 2010 pay 2011 �
Lesser of 12 qq.000 for 2008 paY
Homestead Valuation PeY 2009 47,000 for 2071 2072 $
a 43,000 tor 2009 pay 2010 40,000 payable after 2012
Signawra oilwdifa Date signed (monN. QaY• Y��)