Homestead_Woods (2)"'" CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEna
! ._.. ? STANDARD / SUPPLEMENTAL DEDUCTION
3• State Fortn 5473 (R72 / fi-09j Hc� o
�O � Prewihed by the DeOanment of Local Govemment Fnance
INSTRUCTIONS: See reverse side !or filing instrucUons. " .� / � 1_ /� O Y
�f O( !>
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1(VJe) � � � certify Ihat I(vre) occupied as my (our) prindpal
place of residence or am (are) 6uying the following described real property for which a Homestead Pmperty Tax Standard Deduction is hereby daimed
.�u,n{d}r ronVacl on �he date Uis appliplion is filetl, (dafe o/filiig):
�I(We) ovm ❑ Am (are) buying under recorded conVact
Am (are) entltled to oaupy as a tenanbstockholder of a coopera[ive housing corporation
� Have a beneficial interest in ihe Wst or the right to occupy the property under Ne tertns o( a qualified personal rwidence Wst
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Name of tla' m( al )
l��� �a c�,a
$odal Security OigAS) " ers licertse / Identification Issu'ug Sta
o( da'unant (las( (ive digifs) �/
Name of daimam's s (lepel name) / ��/
Q✓�- U�/�ia
Sorial Secvriry
�� �
. .-. .
If buying m mn�aq Fee Simple oxnefs riame
ReooMe�s ofFice where conVap is recorde0 Record number Page
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�� � Trnmship T' 4isUi rily, /owNn, to ip)
�R
Parcel number L I ' ion�j I e Pery estion:
OS �� ��� '�� Real yoperty � ua0y assessed mohile hane (IC 61.f-n
�If Nm of Ne resdenlial sinxture w Ne lard not exreeding me (1j aQe lhai irtvnediatety su nds Ihat stnrc�re is used m padure inmme, desaibe iha use and paGOn
of perty wTaeC m podure inrome. -
G�lv - /%O�- �%�U-�U�-,��jo/-0�-/
-.• . .: . .
Caunry Tawnship Caunry Township
I hereby certify the above statements are We, cortect and complete. Signamra oi daimant �
Pddress (num6er antl street, ary, state, antl ZlPcode)
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Land not ezceeding t(one) acre immetliatety ;�� �a.�""�'t �'r �' xn
1 u��j, �c�:s��4��`�tc:i
surtoundin residential im rovements. ( � �
�'-''�i' %�°W-`��•..Y,'nz1� J=•.`�
Other land (2) ��:�.�.=:r�.�:
Total land Qine 1 plus line 2) (3)
Dwellin f^`,-_',}��''�+'..rT-?'�v.�'`i'-1 3 J .' -�i�:
9 14) v. �$.'�� �,1ir�-�F-j; t?' .v
Residentlal improvements or Mnualy � -
Assessed Mobik I Manu(acturetl Home Garege (5) �z �7*t+"'�FSKo ,,�� �X`r`-�h='
..� a ^ � t:,*�;�
-�+yee_i� .�
0lherimprovemenis (6) r_ �>�_y,K=.`�`�t^.
7otal impmvemenb (line e through !!ne � (7)
Tofal value (line 3 pl�a Ilne � (8)
I hereby certity the above is true, cortect, Sg"a�� °t�55Of oa:e signed (mmm, tlay, yee�
and complete.
Vedyirig amon - SSnaNre of PLdtor Date signed (monN. daY. Ye�)
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20 pay 20 _ Lesser of 60% of the assessed value of ihe homes[ead or $45,W0
NofwilfGWMirg eny ofie� piovisbn, lhe wm o7the deductidu pro�nded in IC 61.1-17 fa a mobtie Irome fhaf is g
rot assessed as real prvperty a m a menuluctured hane Nat is rot assessed as ieal property maY �t esceed
onehatl �12) of Ne assessed rdlue d Na mob�le Mme w manufactu2d hortie.
Sigriature of Autlltor Date signed (monfh. day, yea�