Homestead_Reed (4)"'" CLAIM FOR HOMESTEAD PROPERTY TAX
� ._ ; STANDARD / SUPPLEMENTAL DEDUCTION
Stala Fortn 5473 (R72 / 6-09)
,�' � PreunbeE �y �he Deparimen� of Loral Govemmen� Fi�nce
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INSTRUCTIONS: See reverse side /o� filing insfrucfions. � �'
I(We) � cerlit�y lhat I�(we) �p%d as�y�(oQirJ prindpal
place of residen r am (are) buying the following described reai property for which a Homestead Property Tax Standard Deduction is hereby daimed
under conVacl on e dale �his appliption is filed, (date o/filing):
❑ I(We) own � ❑ Am (are) buying under recorded contract
❑ Am (are) enUtled to occupy as a tenant-stockholder of a cooperative housing corporation
� Have a benefiaal interest in Ihe Wst or Ihe right to occupy Ihe pmperty under Ne terms of a qualified personal residence Wst
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It buyug om m�tract Fee Simple ownels riame
Remrdefs ofrrz where coniract is recaded Remtl number Page
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Counry Township Tawg S�s �ciN• town, t iP)
Parccl num6er Le9al CesaiPtion �. �O Is piDpertyin 9uesiim:
�Real proDerty ❑ MnuaAy assessed mobile home (IC 6-1./-n
�If any ponion of the rasiden WI swcW re w.1he tand nol ex edi� ane (1) arne t at "unmedialey surtaintls iha[ swcNre is used m pmduce iMOrne, Eescribe the use aM porbon
ot Ne p�operty utilaeE m produce income.
al�-1 9-/8- /o/-ool. /S3-o a6
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Caunry Township Counry TovmsNp
I hereby certify Ne above statemenis are W e, cortect and complete. sign�ure o aimant � �
x AdAress (numDer antl street tl1}; state. and LPcode) � �� A �+ <
C� � uJ ( . �rC o r- r �il 1 / �% ��
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LanE not exceeding 1(one) acre immediatety � ��-�s�i 4��r�3r` ,c�1`s���,�
surtoundin residential im rovements. ( � -�`� - + %�°' '' �-'�•�
��r` f ��� Y
Otherland (2) n �:��"%'t,s".�
7otal Iand (line 7 plus line � (3)
- t ^ yL''y �.I �» cs ,a�':. .w1` .
ResldenUalimpmvementsorMnualty �elling (4) i _�� r���n�?-'��� it"�+�
0.ssessed Mobile 1 Manufactured Homa �,�'* � �"y5 ��r"'
Ga2ge (5) : ::-xY,'`�''.3t'3'�<`+c�,C �j�.�l_'a ''
1�.'"; t.•��f . a
Olher ImO�vements (C) -i a,-- ,r� s s.
7otal improvements (Ilne e Nrough line 6] (7)
Total value (line 3 pl�s Ilne 7) (8)
I here6y certify the above is true, cortect, Sg"a� °��� Date signm (monN, day, yea�
and complele.
VaifyNg a0iai - Signatura ot NWibr �� s�� (^b+�W. �Y, Y�a�
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20 _ pay 20 _ Lesser of 60% ot the assessed vAue of ihe homestead or $45,000
Notwilhstartdug anyWherpiovision, Ne s�m o7Ne detluclions pmvided in IC bf. f-11 to a mobde lame Nat ic g
iro1 assessed as real property a la e manu(eUUred home Nat is rrot essessed as real property maY rnt eroeed
one-hatl (f2) W the assessed rdlue W Ne mobde �wne ormanutactuad home.
Signature ol Audltor Date signeC (�W. �Y. Y��l