Homestead_Estep (3)CLAIM FOR HOMESTEAD PROPERTY TAX FowN �
__ STANDARD / SUPPLEMENTAL DEDUCTION HC�o
State Fwm 5473 (R13 / 12-09)
t / Presaibed by Uie Deparlmant ot LOrel Govemment Finance
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INSTRUCTIONS: See reverse slde !or fiGng ins6uctions.
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I(We) + 1�' certiry that 1 ed a nnapal�•
pla� of residence or am (are uyirg ihe fdlow'vig described real property for which a Homestead Property Tax dard��o��imed
�der mntraG on the date ihis appliration is filed, (date o7filirg). I(We): �� �� �
Own ❑ Am (are) buying under recorded conVact MqR 1� 2� �Z
� Am (are) entitled to oxupy as a tenant-stockholdet of a cooperative housirg corporatlon
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❑ Have a benefidal interest in the Vust or fha right to occupy the property under the tertns of a qualified personal siden .
❑ Am (are) the shareholder, partner or member of the entity that owns ihe property. G�
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NameN tlkgalname)
Soda� Seaniry �u�mher d' t(4st (ne dgds) D' els license 1 Itlentifimtlon !
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Name W dei�(kgal name)
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Sodal Sewriry number of dam�anYS spouse (last five digtts) Driver's lic�va I Idantl0cetion / 01her
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If buying on tonirdct, Fee Simple owners name
Recorders oR�ce where mnirecc is iecorded Remrd numbes Page
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Counry TownshiP Ta�nB 4�� (�+tY• row^. fownship)
Parmi number Legal tlrsuipUon a(J L Is N perty in qu
P� S� a 8- a-� r Real � MnuaOy essessed rtw6�e Iwrtre (IC Gf. f-7)
It arty portion of the residential sWGUre or Ihe land rat ezceetling one (1) a�se Uat ImmeEiattly surtounds that sW�re'a used m produ� uxome, desaibe the use antl pwliai
d ihe poperty utifaed fn Wadure Inmme.
��-ll- a8-3oo-DOO• 598- o a/
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Counry Township Counry Tamship
I hereby certiy the above sfatements are We, cortecl and complete. �"a ot daima�nAt�^
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Address (numbe� aritl sbee4 �'RY. �are, arM ZIP code)
�v � 4a5 � c� � 5
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1.and not exceeding 1(orre) aere Immediatey ��� �� '� �'��`'z''" � 'µ "`�, �;
surroundln residentiaf Im roveme�rts. :=>"^ e �
a�r �_CR J��2
Other land (2) �, Y �.,c.� �._
Total land Qine t plus tine T (3)
9 ( ) `-q_`s.s''t � F"_ � .� ,�s �.- "Z
Reside�al Improvements or Mnually ����n 4 �-�r ���+°''°+t v'�iw, n�+s„�C�^�,
Asaesaed Mohla / Manufactured Home Garage 5 e.,���t ��'��,.�> �`a ��'��Y:�
( ) 3.-t' ,T a_� . �c
� /. �Z" �"� `iV�.
Othar �mprovements (6) ;� �°�„ �� � _.
Total improvemeMS (Ilne I Mrough line 6j (7)
7ota1 value (line 3 pl1s une � (8)
I hereby certify the above is We, correct, �9"a�re otnssess« oate signea (monID. dsy, ies�
and compleffi.
ve;rying aa;on - sigrewm ora,alwr oam signed (monm, ear. rea�
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20 _ pay 20 _ Lesser of 60% ot the essessed value of the homestead or $45,000
NoMiIf4518rMti1g any othefprovislDll, fhe sum d Ihe dLWlxfiDrts poviUe.d in IC 67. f-f2 fo a rtpW7e honre fhBt k $ .
rat essassad as iael property w to e menufactwed home that is rat essessed as real proparty maY �af exceetl
an�hatl f21 dNe assessed value o/the rtro6ile fame w menWachned homa.
Si�aLaeofNWitar �
Date signed (month, daY. Ye�
C. �.