Homestead_Edwards (2)"'" CLAIM FOR HOMESTEAD PROPERTY TAX
i .� STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R72 / 6-09)
�O � Prescnbed by lhe Departmerd of Laal Gaverm�enl F�mnce
INSTRUCTIONS: See reverse side !or filing instnictions
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JUN 9 2011
C .'J.
� �(We) � , certirytt611��ynAUbini�tapva�
place of residence w am (are) buying the tollowing described real property fw which a Homestead Property Tax Standard Deduclion is hereby daimed
under contrad on ihe date this application is filed, (date o/filing): �
❑ I(We) own ❑ Am (are) buying under recorded conVact
Q Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corpora6on
� Have a beneficial interesi in the wst or the right to occupy the property under ihe terms of a qualified personal residence wst
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N o daimanl(kgalname .
Q.6.�-��
SodalSsaciN (uniCr+d da'vnant (bsf
w�y
Sotlal Seamry number
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It Wymg on con5act, Fre Simple ownefs name . •
Recorders afi(r wlu2 mntrad is recoNed Remrd number Page
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Counry TownshiD . T' Q�trict (ciry, town, townshrp) �
Parcel number Legal Caaiption S' .4 � Is Ue p erty in question�
E ao -3 i� ❑ Real property MnuaOy assessed motile home (IC 61.1-n
If anY portion of the rezdential sWCwre w Ne W� not eseMtrg one (1) ane [hat Immediately surtou�Ms Ihat sLUCNre is used to pnduce 4�ooma. Orsaibe ttre use aM portian
o� me wnaem ut� m pioauce rt�ortre.
2!o-/7-ao- �oo_ oo�F.7 7�-o.a./
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. Counry 7ownshi7 Counb Tonnstup
I hereby certify the above statements are We, corteU and complete. � o ai �
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Mdress (numDer aM street, ary, sfete, antl LPCOCe)
41 w i 5a S o�..�..,,:1�., iN '-I'1 �� S
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Land not e:ceeding 1(one) acre immediatety t pzr�',.�a r»=�����"� ,�� r'�
surroundin resldenUal im rovemen5. � I r�,�. s,„_�-g ._,, _�„ .q .'�,P.,-_�,. �,�i';,
Otherland (Z) ,'.-�'�'Y�S'r`�`V{z_-�.�,���'_yA. . ' '
4"-'..� .te;,�r
Total land (line 1 plus line � �3)
Dwelling (4) � �%R�'� '�i�t� - i��. ����
ResiCential improvements or Mnually �. ".�'��sv.�'y,c"??'a�;�
Assessetl Mo01k / Manufactured Hortee Gare e . "F" '� " s�" .
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9 5 ^t.in. . -�'��i��,�v��.;•:7.~�ar`..'��-.'
r c-r-.u�,s.„»���.fi -
Other ImCrovements (6) �}j` -.�„���a+:;?"y �'�
Tofal improvemen6 (!!ne / fhrougAline 6j �)
Total vatue (llne 3 plus line n (g)
I hereby certify the above is true, COR¢M, SigrieNrB Of Atse55or Date signm (monfn, Eay, yea�
and complete.
VeiM�9 action - Sig�uW�e otN#itor Date signed (month. daY. Y��
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20 _ pay 20 Lesser of 60% of the assessed value of Ne homestead or $45,000
NM�Uhsland'eg eny atherP���, fhe sum althe dedcctionsWO�idetl in IC G7. f-f4 ro a mobTa honre Naf a $
nof essessed es ieel property aW a menufacNretl horna Nat is rpf essessed as real propeM maY rwf exceeC
one-hatl (i2J W Ne assessed ralue d Ne mobila home d manufacfured hortie.
Signalure ol Puditor Date sipned (rtronN. day, yea�
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