Homestead_Harvey (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM �
. _ � STANDARD / SUPPLEMENTAL DEDUCTION HCto
f' Slate Fortn 5473 (Rt3 / 12-09)
� y�. � Presaibed by lhe Departmant of Local Govemment Finaxe �
INS7RUCTIONS: See reverse side /or filing instructlons. f
I (We) ' �
placa of residence a am (are) buying the following described real p
�-d contract on the date this application is filed, \
❑ Am (are) buyirg untler recorde
� Am (are) en6�ed to occupy as a tenan[-siockholder oi a mope
❑ Have e benefidal interest in the trust or the right to ocwpy the �
❑ Am (are) the shareholder, partner or membar of ihe entlty that
Mame
d W4fant (HSI fi�e dgds)
Name ot dalmant's spcwse (k'9a� neme)
Sodai Seariry numbel of �lamwrt's spouse
If buying on contract, Fee Simple ownefs name
Recorders ofGCe where comrse
Counry
U
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F` \� \ �yuali
y�
OrivefsGCense/I 'ficet
of Uaimant (last digils)
of daimanYs spousa (leulrve dgrE)
disbiC (ciry; rown, rownship)
1
� M.AY l 1• 2012
C '�
personal residence wst
_._,.,..� rnuNTY AUDITOR
IssWng 9ate
RecoN rwm6er � Pape
Pa(cel number legal desviption a j, ,s rQ C Is tt�e prop6hy in Question:
PE E ti1 F .3 d;3 / 3_ ❑ r�i � �w,�,aur a��a �noa n� oo s-,.,-n
IF arty portion of ihe residu�tial sWCture or the Wnd not exceedinp one (1) acre that immetliatey surtounds ihal strucWre s used m pmduce inmme. desaibe the use aM portion
a me pope�ry uuuzea m proaure �,mme.
�,-/7-3a-aDO-oo3. s�'-1-oa�
Township
I hereby certify ihe above sta[emenis a2 We, cortect and complete.
Land not axcaeding 7(orre) acre Immedlatey
Othar lana
7ote1 land (line 1 plusli�re �
ResiderrtiallmprovementsorAnnually �Iling
Assesaed Mobile / Manufac4�red Hane Ga�9e
Other Improvements
Total improvemenfs (liire / fhroug� line �
Tatal value (line J plus llna 7)
I hereby eeNfy the above is true, cortect,
and wmplete.
Vaifyimg adbn - SigraR�re W Fwtli�ur
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(3)
(4)
(5)
(6)
�8)
Slgnawre of Assessor
CamTy
20 _ pay 20 Lesser of 60% of the essessed value oi ihe homestead or $45,000
NoMifl�sfand'ug anY otAe� provision. (he sum d the Ceductiwrs provifed In IC 6/.7-7210 a rmbrle hane Nal is
not assessed es mal pmpe�ly or to e menWadured home fAet is not assessed as rael propeAy msy rot arceed
S
Townshp
�am
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