Homestead_Kerns (3)""', CLAIM FOR HOMESTEAD PROPERTY TAX
� _ � STANDARD I SUPPLEMENTAL DEDUCTION
State Form 5473 (R72 / 609)
�9 P Presuibed by Ihe Depanmenl of Local Gmemment Frence
F M YEAR
� U10
JUN
INSTRUCTIONS: See raverse side far filing instructions. � �
.
I(We) certiry VfaTQ�we) o�ccupied as my (our) principal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Siandarcl Deduction is hereby daimed
under conVaU on ihe date this applinlion is filed, (date of filing):
�1 (We) own ❑ Am (are) buying under recorded wnVacl
❑ Am (are) entlUed to occupy as a[enanFStockholder of a cooperaGve housing corpo2[ion
� Have a beneficial interest in �he Wst or the nght to occupy the property under Ihe tertns of a qualified personal residence Wst
•- • •
Name of tlaimant (legal name
�N�Y�e�..� S
Soaa� dg7s) Drivefs frcrnse / Iden�
�
Nama of daimani's spouse (/epal name) ^
\tl G 2
Social Secunry rnimb� of tlaimanYs spouse (last five d"g'rts) Orivrls Gcense / IdantlYation / Olher number Issu4g State
of tlaimant's spousa (last five digits)
• ••� �
tl buying om m�trsd, Fee Simple ownefs �wne
Remrtlefs ofire wfiere mntract is remrCed R¢cpd numDer Page
. . � • " � • �
�nry Township Tamg tlistrip (cil}; fown, town ip)
PamxJ number Le9al tlewiption Is �he pmperty in puestion:
' Real property � MnuaAy assessed rtrobile Fiome (IC &1. f-7)
�If any poMion of Ne mvdentlal swcture w �he IaM nol exceeding one (1) aQe lhai immedialely surtounds that swcture is used m p�otluce Irroome, desrli0e lhe use aM portion
of Ne pmperty utl�¢e0 to produce income.
I o?�-1�-/�-/dv-�Tlv. �o-C�a/
... . , : . .
Counry TrnmShiP CaunN Township .
I here6y certify the a6ove ststements are We, cortect and complete. sig�uwre � imani �
AGtlress (number and sfree( ary, state, ard LPmd� ,^� O� /,��
w y
.- .
� . .� . �
i� ..
Land not exceeding 1(one) acre immediatety � jsgt� �' �: �?� r�� �'�'� ��':�
sunoundin residentialim rovements. ( � -�t'.-.-:.�+as�!-�a�ti�?.:...=.T�'3!'`ff�..
:"G: �;,L,�• �:a�;-=r1
'ask. �u:�.
Other lantl (2) ; q�-- �,,.�i�7-�yp`21�4,
7otal land (line 1 plus line � (3)
Dwelling (4) t.i9;y��s3sf"r-�� �"Eh'��ir
ResidenUal improvements or Mnuaity �- ` ic-a ��'� � 3*`;'v�
Assessed Mobile I ManuFacturetl Homa Gara e ��� �"�Y ��'�' =�,��
y (S) t'-t' m"'„�„sFS�'L��s3.r.;..?s:�c:�'
,� . �
O�her improvements (6) � +��,�.-�-� 3� y •.
7otal improvemenb Qine 4 througA Itne 6j (7) �
Total value (IIne7 plu line 7) (8)
1 hereby certity the above is true, cortect, Sigrawra of nssessor Date sgned (martn, eey, ysa�
and complete.
Vaitying acrion - Signawre ofluitlitw Da�e signeE (monN, Oay. yea�
� . - � � � • •
20 pay 20 _ Lesser of 60% of the assessed value of ihe homestead or $45,000
NotwithsfaMirg any o(hei piovisbn, Ihe wm o7Ne deductioru pmvx/etl in IC 67.1-72 to a mobde Mme (hat is g
mi assessetl es real property a m a menuFdcNred hwne Net is not assessed as ieal ploperry meY �t erceed
ona-hal/ (f2) o/ Na assessed va/ue o/ Ne mobEe hama wmenufacfuretl hortie.
s��awre w a,eiwr o� ��ed (.�m. ear. r��1