Homestead_Lewis�
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`"'" CLAIM FOR HOMESTEAD PROPERTY TAX
� STANDARD / SUPPLEMENTAL DEDUCTION
S� State Porm 5473 (R72 / 6-09)
� � Prescnbed by Ne Departmenl of Local Govemmerrt France � a P I3
INSTRUCTIONS: See reverse side /or fil'ug inshuc(ions. '
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SEP 2 7 ZU�U
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� M�e) Q�" certifY 6"i�t'rl�y ��IE¢$s �ul nndpal
place of residence or am (are) 6uying the foliowing described real pmperty for which a Homestead Property Tax Standard Dedudion is hereb�aimed
under conVaA on ihe date this applinGon is fiied, (date o/filing):
❑ I(We) own ❑ Am (are) buying under recorded contrad �
❑ Am (are) entitled ro occupy as a tenant-stockholder of a cooperaWe housing corporeGon
� Have a beneficial interest in the Wst or Ne right to occupy the pmperty under the terms at a quali�ed personal residence Wst
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Name at qa' (k�l nartre) . �
Soda� Seaafry rumbel d da'vnaM (6sf fi�.e d'g3sj OrivKs I'cense / Identi:xation / Other number Iswirig
� al daimant (las! five digrfsJ �
Name ol da' nYs s � a(lepa/ name) ' �
Sodal Seam number of dai 's spouse (last five digGS) Drimiers Gcense / Identifration / Other number Issuing SyR�
of daima�rt's sVWSe (Wst ( � ��/i` J
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If buying on con7ad, Fee Simple ormmls ruma
ReaoNefs of6ce where mntred is remrdetl {�d �yw pegy
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Counry Township Tamg Q�Strict (rlfy, Mwn. townahiP)
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ParceJnumber LepaldesoipGOn IsNa perryv�qupstion:
Rea� P�oPeny ❑ AnnuaOy assesud modle hane (IC 61.1-7)
If any po ' Ne (esidential swcwre or tha WM not exoeetling rne (t ) aae �hal'unmeEiatey su nds Ihe1 sWdure Is used m proCUce income, desafbe Ne use anO portbn
of Ne pro unTaed m pmduce in .
G>''� -//-/% �'�o - oUS�`%9�%- ��/
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Counb TwmshiP Caunty Township
I hereby certity the above stetements are We, correcl arM complete. Signatura o( daimam 1 �
Address (number antl sUeeS aN, steta. eM LP mde)
/� 97 S. o/o� St. .0 .-s��c,�v 1/'✓ 7 70
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Land not exceeding 1(one) acrc Immediatety ��`�'�--+ ��� {s8�'�
surtoundin residentialim rovements. (�) ���� `g-�� r' °�
�-FiST s.._c.z
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Othe�land (p) .z." j .�'.
a.:�='�i�}-�i:
Tatal land (line 1 plus line Z) (3� .
Dwelling (4) - :'��,`�-�q3,'���p�,�i�`-*,�Y-}ti^
ResidenUallmprovemenbmAnnualty 2�. c�Z:i�+S x_ r�;��„_€�
Assessed Mobik I Manutacturetl Home Garege 5 "`��"F-4 �� <�"'��'+�;7'''�s�;`
( ) �"s..�s-r$; r "�'`�-r>'�.'�:H.,��.RSS@s.�.`��.^�.
Other improvemems (6) . p���L��.�X^�� •
Total improvements (Ilne I Nrough Itne � (7)
ToGI value (line7 pllsllne � (8)
I hereby certiy the above is We, cortect, � Sigrawra of Pssessor Date signep (month, day, yeer)
and complete.
VaOying actim - Syrewre of �tor Date signed (rrpnN. EaY. lee�
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20 pay 20 _ Lesser of 60% of the assessed value of the homestead or 545,000 _ .
NotwiNStanding eny otherP/o��. �� a�e tleduCiwa provMed in IC 67.7-72 fo a mob�7a fpmB Naf b $
rrot assessed as real popeiry a lo e manu/acYUred home Nat 6 not assescetl as real propeM mey not exceea "
one-hall (72J o/Me assessed velue o( Ure moEde frome w manufa(tured horne.
S4nature of NMlfar Date si9ncd (monlh. tlaY. Y��