Homestead_Gambrel (2)CLAIM FOR HOMESTEAD PROPERTY TAX
, _ ? STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R72 / 6-09)
�O � Presaibed by the DepaM�ent of Local Govemmenl Friance
INSTRUCTIONS: See reverse side for filinp instnations.
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� �e) , cerh"ryYh�t`I'(�'bL`dd�i20'85Poy'�our) Prindpal
place of residence or am (are) buying the following described real propeAy for which a Homestead Properry Tax Standard Deduction is hereby daimed
under conVac[ on the date Nis appliption is filed, (date ol filing):
❑ I(VJe) own ❑ Am (are) buying under recorded convact
❑ Am (are) enGtled to occupy as a tenanFStockholder of a cooperative housing corporation
� Have a benefdal interest in ihe Wst or the right to occupy ihe property under the tertns of a qualified personal residence Wst
�• • •
Nameo/Uaimam(legalname) C�v,•^' - "
� Ser�ri�'ruuMCV ot da'vnant (6 frvs Cig.is) of da"unant �(rve dicfaation / O�
Name o( qaimanYs spause (lega name) '
Sodal Seamry number of daimanCs spouu (WS( five digRS) Orivefs tirense I Identifration / ONet number Issuhg State
� al daimant's spouse (last frve dgiGS)
• ••� �
tt buying om m�traq Fee Simple ownafs name
RemNefs oi6re where caft2d is rewrCed Recdd number Page
• • � • • t • •
�nry 7ownshiP Tad�u� tlistria (city, town, (ownShiD)
Parcei number L al Aesaip/tio�n� � L Is Ne pertyin quesfi .
T .7{/J �(,(� 9' �' � Real pmpefty ❑ MnuaOy assessed mobile hame (IC 6-1.1-7)
If any portion of Ne resWentlal sVUCWre or Ne IarM not exreeding one (1) afre lhat imme0iatety surroun Iha[ swmre a use0 to D�uce IMane, desrnbe lhe use ariG poition
of Ne properry u0!¢ed tn pmduce inmme.
2�-/1 - 09- /oo-OO�. /Y9-oai
-.• . .: . .
Cowriy Township County Trnvnship
I hereby certify the above statements are we, cortect and complele. y Siy e otetaimam� �
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� aoe�eu`3�amsnce;«n<s7a�e.e�CLP�oea,r-
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Land not exceeding 7(one) acrc immediatety `' ��� �[��-.. �, --. "s *�,�,^x��r'=.
surtoundin resitlentialim rovemenes. (�) �•.?,^,.,.;t��,.,.�__.�;.;��.�;;
cy���_.�;-�...,.;�„�. -
Other land (2) Ri'� y;+*•�`-�"�'=i'
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Total land Qine 1 plus line P) (3)
tT �rl �� � _ ..
Dweliing (4) �..fi.�'x..vi�ii a��.�������'�
Resitlential improvements or Annualty
PssessedMobile/ManufacturetlHOme � ';'.a?� Y-��'��j$ # �^''�'.==
Garage (s) .ti5'.�`++��F��LL z s�� ` '�.
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��is..��_i.r,£a•;;�;,.<:.��; -
Other improvements (6) .�:t,.1�;4�q.:�.'_
Total improvements (line e Nrougn line � (7)
Total value (line 9 phs line 7) (B)
I hereby certiy the above is true, cortect, SignaWre of Assessor Date signed (manth, eay, yea�
and complete.
Veityin� aaon - S5naNre W Audicor Datc signed (rtronN. tlaY. YE�
� . - � � � • •
20 pay 20 Lesser of 60% of the assessed value of ihe homestead or 545,000
NoMi(ASlariding any olher plovi5ion, tl�e wm d Ne dBdutGDnS prOVitletl in IC 67.1-12 to a rtmbde home Nat ic S
rot assessed as real property or ro e rrenu7ucfured fame Net is not assessed as real properry maY �t exceed
one-hatl (72) of Na assessed velue a/ Ne mobda �ome w manulaGUBd home.
SignaWre NAUtlitw Date signeC (mm1h, tlay, yEa�