Homestead_White (5)�
OCLAIM FOR HOMESTEAD PROPERTY TAX
S STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5073 (R72 / 6-09)
�� � Prawibetl by U�e Departmerit of Lo�l Governmeiri F�nce
INSTRUCTIONS: See reverse side lor fililg inuruuions
�
FORM YE�
E� r�c�pZU10
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I(VJe) certify that I(we) occupied as my (our) prindpal
place of residence or a are) buying the foliowing described real property for which a Homestead Pmperty Tax Standard Deduction is hereby daimed
under conVact on Ihe date Ihis appliption is filed, (date o7filing):
❑ I(We) own �❑ Am (are) buyi`g under recorded wntract .
❑ Am (are) entiLed ro occupy as a tenant-stockholCer of a cooperetive housing corporation
� Have a beneficial interest in ihe Wst or the right to occupy ihe property under Ne terms of a qualified personal residence Vust
�L. � !_ _ / S�
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If buying m mntrap, Fee Simple ownels nama
RxoNels ofifr whem mntraa ¢ remrGetl
Caunry
Pemsl number
Township
D(ive/s Gcense / Identfrat
of tlaimanl (lasl frve d'g2s)
of cfaima�rt's s7�sa (Wst Rve dgdsi
Tam�g d�sfrirl(rity, town,
Is
Issui�g ar�
Remtl numbrl
Page
/�I C /"' �.� — r� U Reat property � U MnuaOy essessetl mob'le home (IC 6f. f-7)
If eny portirn of Na resdential SWCN�e u Ihe IaM nol exceed4g me (7) aae ihal immedateh/ wrtountls Nal6UVCWre is used to Wodum irimme. dsamDe Ne use and poROn
�or me a�vem wazea m w�� mmnm.
a�a - � � - o � — � foo —v o o_ �� 3 -o �/
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ro.msnip
I hereby certify the above statements a2 W e, correct and complete.
Atltl ss jnumDe� antl street, ciry, alate, and LPOOOe)
d � Q
. �• �
LanE not esceeding 1(one) acre Immediatety
aurtounCi`g reslCential improvements.
Otherland
7ota1 land (line 1 plus line �
Resldential improvemen�s or Annualiy �����9
0.tsessetl Mobile / ManuFactured Home Garage
Other Improveme�
Total Improvements (line 1 fhrough line 6)
Total value (Ilne J plts line 7)
I hereby certiy the above is we, correct,
and complete.
vaur� aaa, - sgnamR aa,a�� •
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(4)
(5)
(6)
CouMy
1�.�
20 pay 20 Lesser of 60% of Ne assessed value o( ihe homestead or $45,000 �
NotwrthwrWug eny otherproNSion. ihe sum N(he tleN�ctions provided in IC Gf. f-f2 ro a rtabJe home ihaf !s g
not assescM as �ael property a 10 e manu/artured hwne Ihat is rot essessed es real Property maY nof esceed ..
�
G�BSUN
Tovrtahip .
Date Wgned (rtrontA. daY• iTa�
tl, i s loio