Homestead_Smith (12)"'" CLAIM FOR HOMESTEAD PROPERTY TAX �� YEaa
�!'�-_ � STANDARD / SUPPLEMENTAL DEDUCTION Hc�a
Sta:e Form 5473 (R72 / 6-09)
�° ,�,� = Prewibed by lhe DepaNnent ol Lo�l Gwemmen� F�nce � p R� � u � U
INSTRI /CTInNS� Rcw mwrsw eNn /nr fir;.�.. ;�oe..i��M�
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�(yye) GI�SON�C�C�U�Nat I(we) uocwp ed as my (our) prindpal
fy
place of residen or a( buying Ih Ilowing described real property for which a Homestead Pmperty Tax Standard Deduction is hereby daimed
u r conVact o e date this application is filed, (date o/filing):
I(We) own ❑ Am (are) buying under recorded convact
❑ Am (are) enlitled ro occupy as a tenanFStockholder of a cooperetive housing wrporauon �
� Have a beneficial inlerest in the Wst or the right to occupy the property under Ne tertns of a qualified personal residence trust
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Name o( tla'unant (legal neme) T `^ �
V Q T � 2
Saaa�Senudynw�
W da'unam (las( (rve d'gitsJ
Narne of qa'unant's spouse (lega/ nartre)
I. Sotlal Securiy number o1 tlaimant's spouse (last Irve tl"gifs) Orivers license / Identifra6an / Other number Issuing Stata
oraa'unanrs saWSa (wsf rnre a;yits/
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If buying om m�trs0. Fee Simple owneYS �ume
Remrdefs ofice where mntraa is remtled Record numbu Page
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Counry Township T' isVid (fily, rown, fownshi0)
Parcel number LegalOesuiplion Is pmpeRyin question:
eal property ❑ MnuaOy asussed rtabile home (IC &1.1-n
�11 any ponion ot ure residential swcwre or Ne IaM nol exteeding are (1 � aue ihat immediatey surtwntl �hat sWCW �e is used ta pmdure imnme, descnba the use arW porUOn
af Ne pmperty uoT¢ed to produre inmme.
� alo-��-35-3cx-vo . -o
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Counry Township Counry Trnmship
I hereby certify ihe above statemenu are we, covect and complete. re of n �
i
ress er reel,dry,sf fe,aMLPOOde)
� QD OWPN ' e
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lana not e:ceeding t(one) acre immetliatey � � Y�,�s�}-�?t-,tir�` +'�L=� "��
surtounAin residentialim rovements. � � �}+�.+r.'�.� .r '�,.Z.e�°k�
_._. _., r:�.-=.,a7�� S '
Other land 2 :'�'c�' ' �' �-
( ) r:a•_.3c'.r.x�?+'P,c<.':
Total land (line f plus line 2) (3)
:�� .�-,k� - `
Residentlal improvements or Mnualty �`"�elling (4) c�+ s��r�k, �3h �' ��_ ;�
Assessed Mobiie 1 ManWactured Home Garage (5) ���-�s� v�',�',���r�,,n c�:�i�;
L ".-�i i.�1
other improvemenss (6) � r-� � ,�i�f�';,'.Y'.-,,�
Total Impravemen6 (line I through line 6j (7)
7otal value (line7 phs Ilne 7� (8)
I hereby certiy tha above is true, cortect, Sigrewre ofAssessor Date sgned (month, day, yea�
and complete.
Vaih�irg acbon - SigfaN`e ot Audtw Date signed (monN, tlay, yea�
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20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
NohvilhslerMing any olherpmvision, Me wm o71he daductiw�s providedln IC b f. i-f2 ro a mo6�e Fame Naf is g
not essessed as ieal property w Io a manuhacmred hwne Nat a rrot assessed as ieal pmperry may mt ezceetl
me-hatl /72) oI Na assassed value olthe rtp6de home or manufacturetl home.
SigriaWfe olPUdltw oa� �q�m �r�w�, eay, y�.,�