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"'" CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEna
STANDARD / SUPPLEMENTAL DEDUCTION HCto
State Form 5473 (R72 / 609) .
�° � PresuiDed by the Depanmenl of Loml Govemmefrt Fnanca . . .
/NRTRI /CTinNR� .Cnn mw.co ciAn /n. FGn..:nm..,�u....�
� • � � .
I(VJe certify Nat I(we) occupied as my (our) prindpal
place o( residence or am (are) buyin e following described real pro �or which a Homestead Properry Ta:�d�l [�Jedd�l�j is hereby daimed
under conVaG on the date this a IicaUon is filed, U C l. G V�
PP (date of filing):
❑ I(We) own ❑ Am (are) buying under rewrded conVact ,�y/ ,/
❑ Am (are) entitled to occupy as a tenanFStockhoider oi a cooperetive housing corpo2tion v'( ���'Oi
� Have a benefidal interest in ihe Wst or the right to occupy the property under the tertns of a quali e� ��,e���R
,. . �
Name af tla'unanl (kgal name) .
�
� Soda�
N e of daMaM's spouse ( 1 name)
SWaI '
��M•s�����,���i a�;�
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II buying om m�trad, Fee Simple owners rame .
Remrtlefs o(fi�x where mnvect is reooNeO . Rcmd number Page
. . � • • � • •
Couniy � Twmship Tax"vig tlisbiG (fity, , to�nishiP)
Pa�cel number Legal desttiption n •/y� Is Ihe propeRy in Question: �
' �� / /" / Z Z Z � � Real property ❑ Annuapy assessed mobile home (IC 61.1-�
�tt arry portion N Ure residen�lal shucWre « Ure IaM not axceedUg me (7 ) ave that ImmeEiatey wrtouMS that strucNre is useC to protluce ifroort�e, desalbe the use and portion
01 tl1e P�oPenY u0'Bzed �a P�utx inmme.
��18-�3-4o`f-oo/. J�{3 -D a�
-.� . ,: . .
Counry Township Counly Tawrahip
I hereby certify the above statemenis are We, corteG and complete. � S' wre of daiman� �
dress(numberandsLeef.ary,sfate ntl PcoCe) .
ao s. �, . �o �n�.�-, �N y
.- .
. . .. . .
„.. �
Land not ezceeding 7(one) acre immediatety ��� x,� �'�' `�`�'�� —�•;,
surtoundin resiAential im rovements. (� � ���`��.���-�� F�'w
� Other land � (2) � _ :�`����
.. �.��i .... r•��;t.. _
Total land (line 7 plus line � (3�
9 ( ) �s��'�� �t.�,�. ,.�$''�A ?'aHyt
Residential improvemenb or Mnually ����� 4 x�:..+-_ s,a�:'_ �«s�:.v_x x,.:� E
Aurssed Mobik I Manufactured Home 9 (5� �� �7"s'j�ys�.T'�`„�"�h����i,;��
Gare e {�/� 3d`N� r.•.-.c.+'��r'3`e�+.(3'.,7.. ai+.-
Other ImprovemeMS (6) �;��,:���k�'+}�:
Total improvemanb (Ilne e NrougA line � (7) .
Tofal vatue (Itrre 3 plls Iine 7) (B)
I hereby certify the above is true, cortect, Sig�ture otASSessor Date Wgnetl (monN, day, ysa�
and complet¢.
Vaih�rig a�on - Signawre ofluMitn Dace signetl (monN, day, yea�
� � . • � � � � •
20 pay 20 _ Lesser of 60% ot the assessed value of ihe homestead or $45,000
NorteVhstaMing enyWherproNSbn, Ne s�m o1 Me dedurliau proNded in IC 6-f. f-f2 ro a mobAe lame Mat is $
not essessed as leal property w to a manNerlured hort�e Nat is rot assessed as real pmperry may rqt exceed
one�haH (1R) W Na atsessed rdlue o/Ne rtpDie home or manuFattu�ed Mme.
Sig�awre of NMifor Date si9� (�N. tlaY. Yea�
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