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CLAIM FOR HOMESTEAD PROPERTY TqX _
. STANDARD / SUPPLEMENTAL DEDUCTION
S v State Fortn 5473 (R72 / 649)
�O / PrasUiEetl by Ne Departmenl of Lacal GovammeM Frmnce
INSTRUCTIONS: See rererse side for filing inst/uctrons.
�'� F YEAR
�1 �
CFP ] Q ZUIU
I (We) / "'o"�(ti�y`Uiix�l�y'b�.igFgs my (our) prindpal
place of residence or am (are) 6uying the foliowi described real property for which a Homestead Property Tax Standard Deduction is hereby daimed
under.conVact on �he date lhis appliniion is fil , (date o(filing): .
❑ I(We) own ❑ Am (are) buying under recorded convact
❑ Am (are) en6tled to occupy as a tenanasrockholder ot a cooperative housing corporation
� Have a beneficial interest in fhe wst or the right to occupy the property under the terms of a qualified personal residence Wst
Narne of daimanPs spouse (lepa/ nartre)
Sodal Seamry numbc M Uaimant's spouse (laz
If buy'vig m mntrad, Fee Slmple avmnls rume
ReooNefs ottke where cmtract s recortled
Counry io
Pa`cel number
OrrveYS Ikxrue I laenti:rafion
of tlaimant (last five digifsJ
a aaimanrs sv�e (last rne
Legal desaipiim
� I ���y �n.c
Issuing Scate
Rcmd rwmber - Page
tt any pwtion d Ne residen�Wl sbucWfe or Ure IaM not e�¢eed'uq p» (1) aae that immetliatety sunouiids that snurYu
� ot Ne P�oPaM u0lhed ta P�ure u�mrre.
a(� -1 � l 3°�/0 3�00. 3 7� -a a-G
��
Tbwnship
I hereby certify the above statements are we, corteU and complete.
Pddress (num6er aM afreeS �: sfste, and LPmOe)
Und not exceeding 1(one) aue Immediatety
Otherland
Total land (line 1 plus line �
Residential improvemenb or M
0.ss�sed Mobile / ManufacNred
Other improveme�
Dwelling
Garage
Toql improvemen6 (line I thmugAline �
Total value (llne J pl`s Iine 7)
I hereby certify the above is true, cortec[,
and wmplete.
Vailying action - SignaN2 oi Auditor
(2)
(3)
�4)
(5)
n)
(8)
Sigria¢rta af Assessw
Caunry
Qu�ibn:
e+ry ❑ MnuaOy assrssetl mo00e home (IC G7.7-7)
ie is useE to P�uce Inmma. Cexribe ihe use aM portion
20 pay 20 Lesser of 60% of the assessed value o( ihe homestead or $45.W0
NWwtlhsfaMUg anY �erP���. �� o!(he Oeticrlions provMCM in IC G1.1-f1 to e moblla home Na( is $
nof assessed es real poparty aW a menu/achlred hwne Nef 6 nof esse:ced es raal properry maY rpf axceed
me-hatl(12) oI Na assesse0 velue oI Ne mobHe hortre wmanulaGUred horrie.
s��n� m wen�
Date signed
�n
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