Homestead_Frizell1�
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"'" CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
S v State Fortn 5473 (R72I6-09)
�° % Prescribed by NB DepaM�etrt of LOCaI Govemmenl FnancB
iNSrnucnoNS:
(date of filing): �
�❑ I(We) own ❑ Am (are) buying under recorded contract .
❑ Am (a2) entiUed to occupy as a tenant-stockholder of a cooperative housing corporelion
� Have a beneFldal interest in the wst or the right ro occupy Ihe property under the terms of a qualified personal residence Wst
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Name ot damant (/
Name of ' s (legal me) .
$odal Seauiry num
Q J
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If buying on contraq, Fee Simple v.mefs �wme
RecorCefs affire where contraG is 2mide0 . Remrd number Page
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Tornship Taz'vg disinct , t ip)
gI�'rcel miimber Legal desaiptim ' Is pro � quesGon:
(x m—� _, I pmperty MnuaDy e home (IC 6f.1-n
If any portim of Na �e5den�lal sWCW�e a 1he Wnd not exreeCing arre (1) aae that Immediately surmund Ihal sWCtu�e is used to proAUce Noome, tlevnbe the usa and portion
of Ne property utS¢sd b protluce inmme.
• � • • � a • •
Counry TrnmshiD Caunry Towns�ip
I hereby certify the above ststements are We, correU and complete. Signaeue ot dai� mant _„ I �
l 1 Wrh�l� (�`'i,
Pddrass (numbe� antl sveef, cdy, stata, eM LP cotle)
o��q �,.i 1s� s ow e SN `-E1lo(o5
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Land not exceeding 1(one) acre immediatety � �Z',�+�'niy y'' ,'�s3-"`�'; �
i . 3 �Y..;,�•�'s'�'•t"fr�„��._.�%„
surtoundin residential im rovements. � � � s
Otherland � (2) h'�.�'.,��j���`
Total land (line 1 plus line Z) (3)
o�ir�s (<) �'����'� �`��'�'��'��
Resldentlal improvemenb or Mnually
Psssssetl Mobile I ManufacG�red Home �:�n'�Y a��r 3`�����
r
. Garege (5) . .:.isur��:..'7 �. ''��'?-�'' �sY;k 'P-``
Otherimprovemeirts (6) ' ��"q����'��
Total Improvementt (Ilne 4 thmugh line � (7)
7otal value (Ilne 3 phc line 7) (8) -
I hereby rertify ihe above is true, cortect, SlgnaWre of Assessar , Date signea (rtwnfh, dey, yea�
and complete.
Vaityin9 aUion - Sigrawre oflu�6tw Date signed (rtronth. tlaY iTa�i
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20 pay 20 _ Lesser of 60% of Ne assessed value of the homestead or $45,000
NonviNSland'ug any ofherpmvision• Ne sum o1 the deducliau prointleO in IC 6f.1-12 ta a mo6�e home lhat fs $
�rot auBSSed as /eal propeiry w lo a menufaW/ed home Nef a rpl a5sessed es /eel pmpeny may rrot exceed
oriehaH 12J W Ne assassad re/ua d the mo0'!e home or manufaWred home.
5" � Dafe ' Y.