Homestead_Warren"'" CLAIM FOR HOMESTEAD PROPERTY TAX
i, ._, � STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R72 / 6-09)
�O � Presaibed hy the Departmanl of Local Govemmanl Friance
INSTRUCTIONS: See raverse side lor filing instruc(ions.
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FEB 1 2 2010
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��e) , celtlfy�l�( ied as my (ourj principal
place of residence o (are) 'bed real property �or which a Homestead P�e�T����y�Ris hereby daimed
under Vact on Ihe date Nis a lira6on is filed, �'
PP (date offiling):
(We) own ❑ Am (are) buying under remrded conVact
❑ Am (are) enliUed to occupy as a tenant-stockholder of a cooperetive housing corporation
� Have a benefidal interest in the Wsl or Ihe right to occupy ihe properry under the terms of a quali(ed personal residence Wst
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If buying am m�tract, Fee Simple ownefs name
RemrOers of&e where mnVaG is reco�deE Ret�.ofd num6er Page
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�nry Twms�ip Tabng distriU (cify, town. townshiD)
P n�y�ng r L al AestYiption Is Ihe property in qu�tion:
a6 -I 1�/ � b' ❑ Real property ' ❑ MnuaDy assessed mo6ile home (IC 6f. f-n
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tt arry ponion of the resiOenUal sWCW re or Ne W W no� exceed'uig ona (i) aQa �hat immeEiatety surtourMs ihat sWCtu2 is useE tn produce incane, desrliGe Ihe use aM portion
of Ne praperty unT¢ed to praduce inmme.
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CaunN Trnmship
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Land not esceeding 1(one) acre immediatcly �� ' ���;� � Y�'X'�,�"�hy�� 9'.s��i�
surroundin resitlential im rovements. (� =.`� n'^+ 2:hA. ��i.��„`-s;-_
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ONer lantl (2) �-�- :!}����^`
Total land (line 1 plus line � (3)
}°+'�"� �-e� ""� y`�tr`. 1
Dwellin9 (d) C:Sk".c�C`�t$��t�tv�E:ea�=
Resldential improvemenfs or Mnually -
AssessedMObile/ManufacturetlHOme � ��5£a ���,c y ;-5�'='
9 (5) ? % 3v �
Gara e �L ., , �� +-�
�' ,sr� 4 .ubs:r*r...'
Qlherimprovements (6) �'�: ='-�is�;':�'-'�.•.
rL?u�
7otal Improvemenb Qine I Nrough Ilne 6j (7)
Total value Qine7 pl�s 1lne 7) (8)
1 here6y certiy tha above is hue, cortect, Signah�re ofPssessor Date signed (monN, eay, yea�
and camplete.
Vaityi�g aaion - Signawre ol Auditw Date signeE (monih, tlay, yea�
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20 pay 20 _ Lesser of 60% of Ne assessed value of �he homestead or 545,000
I No(wifRSlariding enY �erpio�.isiori. Ne sum d the eetluctions pmWetl in IC 6-7.7-72 ta a nnb�e Aome /hat is g �
not assessed az+eal property w(o a rrenufertured frome lhat a nof assessed as ieal piope`ty may mt erceed -
one-haH (12) o! Na essessad value o/ Ne rtpAde �ome ar manu/acfuretl hm,e.
I Signature of Autliinr Date signeE (rtqnth, day, yean �