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Homestead_SmithC� � � "'" CLAIM FOR HOMESTEAD PROPERTY TAX _ ; STANDARD / SUPPLEMENTAL DEDUCTION 3 Stata Farm 5473 (R72 / 609) �O � Prascnbed by Ne DepartmeM o1 Lo�l GovemmeM Friarice w.crR�ir.nnN.r .c�,., ,.a,,,,.�a �;n< r,,, er,.,,, ;��m,�r�.,� I, , `� � ; { ': � ��, APR 8 2011 . . � M/e) certiry p�g�3N� 4C6#1!H'dsFhi�RlS�}R+ndpa� place of residence or (are) 6uying the foliowing described real property for which a Homestead Property Tax Siandard Deduction is hereby daimed under mnUact on ihe date Nis appfintion is filed, (date o7 filirg): �(wej own ❑ Am (are) buying under recorded contract � ❑ Am (are) entitled to occupy as a tenanbstockholder of a cooperadve housing corporation � Have a benefiaal interest in the Wst or the right to occupy the property under the temu of a qualified personal residence wst •• � • Nama ol dairtiant (lega ame) � � SodalSencity nmbei d' (69 frve d'gk) Drivefs Icense I Identi& NamB of da'unanYS 5pouse (legel nameJ Sotlal Securiry mimEm of daimanYs spouse (lazt five tlig'rts) Drrvels licanse I ICentifration I Other number Issuirig State ot daimam's spouse (lasl frve dgitsJ • ••� � tt buying om m�tracT, Fee Simple ownels name ' Reoordefs otfice rfiere rvntraG ¢�emrdeC Remrd num6er Page ..�. . � . � Counry Township Tadng dittriG (rity, Mwn. townshiP) Parcel number Legal desai0� Is ihe property in ques6an: ' I property ❑ MnuaOy assessed rtroWe home (IC G7.1-� I( any portion W Ne 25idential swcwre or 1he Ia�M not erceeC' s Nat sWCNre is used to produce incartie, desuibe the use aM portion or me woaem �m'raee m w�uce inmm�. � o aoo � 5oao o ! -.. . .: . . Counry � Township Caunry TowfaNp I hereby certiy the above stetemenu are we, cortect and complete. S�qnature of daimant . �_ � �� / Pddress (number and sfinef, tlry, stete, and LPOOde) 8/ S O 50 (.c) .��e .�N 7(.CS— �. � � • •� . � �� .. �Land not ezceeding 1(one) acre ImmeCiately `?y=`%9:ysr,,, ,�..�'.�-`m�"�" �` =�- surtoundin resldentialim rovements. (�) -'�i-^��'-�����fi.����s. ti. . ( ) ,s�.i. z Otherlantl 2 "" � •��' . �'?�:-. o'. Total land (line 1 Olus line � � (3) ' �'+H� a +i,� ti% Resldentlal improvements orMnualty �Iling (4) �� �- �` '�a�'z' .�+'; `R�t9`*K.'�.., �sa's�-+,., x r6. Assessed Mobile I Manufactured Hane Gare e �µSK�^i ����„� �.�' 9 (5) £•.'�T>..�?'?F?�������T�R._.��� � . ONer Improvemems ' (6) • �y,�y�.,���y'���+ Tofal improvemenls (line 1 thraugh line � (7) 7oql value (Iine7 plls line 7) (B) I here6y certify tha above is We, cortect, SignaNre ofAsmssor Date signeC (monfh, day, yea� and complete. veifyitg ecfan - Sig�aN�e of Puditw Dace signed (month. EaY. Yea� • �.-� � � � • • • 20 _ pay 20 _ Lesser of 60% of Ihe assessed value of ihe homestead or $45,000 � NohNNSfarbing eny atheiproNSion, Ihe sumW the detluc(iw�s pro�+tletl in IC 61./-12 to a rtmElle froma Nat is $ not euessed as ieel property w ro a menWaUUred hortie that a rpf essesced as raal property mey rot exrsed onaJ�atl (12) d the essessed vehre a71he mo6ia home ormanufaclured hortie. SigraWre Aud� � Date signed (month, day, yea� — �'