Homestead_Sisk (3)" CLAIM FOR HOMESTEAD PROPERTY TAX FORM Y�R
- CREDIT/STANDARD DEDUCTION HCio
� � Stata Form 5473 (R8 ! 7-07)
Preunbed by Ihe DapaNneM oF Laral Govemmenl Finance
INSTRUCTIONS: See reverse sde !or filing instruc6ons.
��e� vi certiry tdIaILOn th7e777��� t t March. 20
I(We) occupied as our prindpal place of residence the following descri al property fw which a Hwneslead R6�e�rty iec��� hereby daimed:
� I(We) owned ❑ Are puying under mntrad
�
Have a benefidal interest in ihe entity that is IiaWe fa the properry faues on Me property and that owns the prope�rty�"'o�n�siwN{�igunder a contrad.
H b�ryuig on canVact, Fee Simple amefs rmme
Racordars of6ce where contrad is recortlad
Counb Twmship
Tm�ing disinq (cify, fown.
Record number � Page
Paicel number l al descriplion 3•3 Is Ihe in
[+,(' y c I a ���:
�T ` SC / 9- a-ii ❑ Real ❑ Mobile Fbme (IC 61 f-n
If arry partion ot Ihe residential sVUdura « Iha land nd e:�ceedirg arre (1) aae Ihat immediately wnwnds that sUUCture is used to produce income, descnDe Ihe use and portbn
d �he property uli6zed to produce inmme.
�2G -��-�9 -�foo -�oo. 8 y�- o�,
Twrnship
I hereby certify the above shatements are true, correct and complete.
and stree4 dly: stafe. antl LP code)
S_ ecn �� �oS
Counry
6
._ � . . .. . �
�� .. �
LarM nol ex�ng 1 (orre) aae immediately -- - ' - :`- �.': �: -.. � .. " -
.-t:, :.: �:
surtounding residential improvements. ��� ' - - - - -
�:;. ii..':: -: :;�_i . _ -
OthCr 12(M (p) .. .
Tdal larnl (line 1 plus I"ure 2) (g�
owen�rg (a� . -- :. . . �
Residentlal improvemenis or Mnually ' - -
Assessed Mobile I ManuFacWred Home -. .. . .
Ga2ge �5� ' . .
O�her improverttents (6) - _:' �`-: � .
TUaI improvements (frne 4 through line 6) ���
Tofal value (line 3 p!'s Urre n (g�
I hefeby Certify �he abwe is We, tortett, ard SignaWre of Assessw Date signed (mmlh, day, yea�
complete.
Vaifyirg actian - SigreWre of �mr pate signed (monN, day, yea�
� • �.-� � � � •
�Y Z� — 45,000 for 2007 pay 2008 42.000 for 2010 pay 2011
Lesser M 12 qq.ppp tor 2008
Homestead ValuaGrn PaY 2009 41.000 tor 2011 pay 2012 $
a 43,000 for 2009 pay 2010 40,000 payable after 2012
SignaWra oflwdbr Date s9ned (martA.OaY•Y��