Homestead_Michel (4)�
�
�
�
"'^ CLAIM FOR HOMESTEAD PROPERTY TAX
. _ , STANDARD / SUPPLEMENTAL DEDUCTION
.. State �orm 5473 (R72 / 6O9)
S f PresaibeE by Iha DepartmeM of Loml Gavemme�n Frerice
� � ��.
.' i ,��
�
�'� � 1
C.�.
lNS7RUCT10NS: See rererse side for filing insWCfions. "�
I(We) • certify that I(we) occupied as my (our) prindpal
place of residen or am (are) buyi g the f owing "bed property tor which a Homestead Property Tax Standard Deduction is hereby daimed
under conUaq on the date this applica�on is filed, (date of filing):
(We) own ❑ Am (are) buying under recorded contracl
Am (are) entitled to occupy as a tenant-stockholder of a cooperetive housing corporetion
� Have a beneficial interest in the Wsl or Ne right to occupy the properry under the tertns of a qualified personal residence Wsi
.• • •
Name of d0unant (k9a1 name) �
Sodal Seamy d' (6sf tn.e ) Drivels Gceme / Idrntifi�tim / Other number Issu'vg
� � of da'mant (lasl frve digifs) � �
Name of tlaimanYs spousa (lepa/ name) '
Sodal Securiry numbar ot dalmanYS spouse (las( five digifs) OnveYS licensa / Identlflcallon / ONer number Issuing State
. of daimarrt's spouse (le9 frve dgiGy
• ••� •
II bvyin8 on oontrac� Fre $imple ownefs riame .
Reoordefs ofirc where mntreG is recordeA Record number Pape
. _ � • _ � . �
���y Township Tamg d�striq '. lown. town,Nip)
Pafcel num6er Lfe�gal pEesaiD� Is Woperty in Queslion:
� v O� �' � D�DeRY ❑ Annua%assessetl modk home (1C 61.7-n
at Ue poperty u76ied to aoOUte inmme. 1he IaM �rot exreeCtrg one (1) aoe Nat immeEiatrJy wrtou�W Ihat sLUmire is used b praduce inoonn. AsaWbe Ihe uu ab poroon
• � • • � a • •
County Tv.mship Couny Townsttlp
I hereby certify the above ststements are We, correG and complete. Sign ure o1 daimant •
Address(� berand cily (ete. ndL cade) ��
i
� • . � • �
• � �i'. �
Land not e:ceedi'g 1(one) acre Immedlatey 1 . .�k'a`� �'�'`S''�' r� nf�•� ��
surroundi rnsltlentialim rovemen5. �� �" s._.i'.�},cr �,.ak a�-:�'x
' e� ax�,*s _
Other land (2) ���,.�-�..'t��`
Tatal land (line 1 plus line 2) (3)
s����xx w� ��
Rwidential improvemenb or Mnually �����9 �4) �"'""�y'�'^' '�s�' -i`� `�
Aurssetl Mobile I Manufactured Home Garege (5) >��'- '�:4�`n+��''�r"..cy,�
;s> },�_x.i!E?i: SL`X'+%'i.'%ty..�
-x_r:.. #i�`ns- 4
Other improveme� (6) �"��e'S,,��,� .,,
Tofal improvemenb (llne 0 Niough fine � (7) -
Tofal value (line7 pl,s line � (8)
I hereby certify the above is We, cortett, SigruWre of 0.sseswr Date signed (rtronlh. day, yea�
and complete.
Veifyi� aclbn - 55�awre of Auditw Date signed (rtronth. OaY. Y�
�.-� � � • •
20 pay 2b Lesser of 60% of the assessed value of the homestead or 845,000
NonriMSlaMUg eny other piovision, Ne sum d the detlurtionc proviJed in IC &1.7-12 ta a rroDde Iame tAat is g �
nat essessetl az reel property or IO e rtlenulet�red hwne fhaf a not dssessed 85 reel plopBlly mBY �1 Bxreetl _ . .. .
wiehal/ (iRl «� asussed velueW Ne mobde lwma wmanufaWred horrie.
59nature M!v#itnr Date signeG (monlh. day,
`-1 - -
_ __ , __ -