Homestead_Bittner;,._rt" CLAIM FOR HOMESTEAD PROPERTY TAX
. '� STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R72 / 609)
�� Prescribed by Ihe DepaNnent ol Local Govemment Flrence
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INSTRUCTIONS: Sae raverse side lor fili�g insfrucfions. � �
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I(We) certifyGthat I(we) ocwpied as my (our) prindpal
place of residence or am (are) 'ng the following described real property for which a Homestead Property Tax StaMard Deduction is hereby daimed
under mnVact on Ihe date this pplica�on is (led, (date ol filing):
❑ I(We) own ❑ Am (are) buying under recorded wntract
❑ Am (are) entltled lo occupy as a[enant-stockholder of a coope2tive housing corpo2tion
� Have a benefidal interest in the hust or the right to occupy the property under Ne tertns of a qualified personai residence Wst
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Name of imant (k9a1 nama)
Sooal Seariry numbc of ' t(ks! dg3s) Orivers frense / Identifiration /
neme)
Sorial Seamry number o( daimant's spouse (WSl !rve tl'grts) Drivers Gcense / ICenGfmation I ONer number , Issuin9 State
ot claimanfs spouse Qast frve d'gits)
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11 buying on conVac� Fee Simple ownels riame �
RemNets ofice where mnVeQ is rewrCeE Remrtl number Page
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�nry Tovmship Taxvig Q�Irict (cify, town. (owrtchiP)
Parcel number Legal OesaiP� • Is 1he poperty in 9uestlm:
� S� � O �Real PmPertY ❑ AnnuaAy assessed rtn6ile home (IC 51.1-n
�If any ponion of Ne readentlal sWCture or Ne land no� exmeding me (7 ) acre [hat Immediatey wrtounds Ihat slruGU2 is useC to pmduce Income, desaibe 1he use aM poroan
o( Ihe O�PenY utif¢ad ta ptotlufe inmme. �
��-19, �7- 300-00l. �sl-oas
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Caunry 7ownship Caunry ' Towrv�hip
I hereby certify the above statements are we, corred and complete. w^Qeture or daimam . '
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AOtlress (rwmber aM shaet, dry, slafe, end ZIP ootle)
z s L=. S o � G 8 T. ,6/I/fil�Uf /N � ya'
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landnotezceedingl(one)acreimmetliauy � ��� ��a�e,°°'ft���,"�-"���
surtoundin residential im rovements.
'r.s�::;d 2 S�'_eL^� x
„K- -r�{i - l.. �x�
Other land (2) :.�i':.�,� :'r��:�-..,'";.^
ToGI land (line 7 plus line 1) (3)
t.s`��' .,, �;,a�s�,y � k�'F �
ResldentlalimprovementsorMnualty �elling (4) „i=;.,A�� •e+ xfh-.��,`S.,.p! ��.3
Assessed Mo6ile / Manuhctured Home Garage (5) ,ix� ,y�°".,'`., ����i ,�;;r;�-r ��;
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Otherimprovements (6) ' ��+�-'�v'r�'�'� �
Totai ImprovemenCS (Ilne 1 Nroug� line 6j (7)
Total value (Ilne 3 pl�s Ilne � (B)
I hereby certify the above is we, correct, Sg"'°"e °fASSess°` Da�e s9^e� (ma^!h• tlay, year)
and complete.
Vaityi� amon - Signawra ot Auditor Date signetl (mwrfh, day, yea�
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20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwi(AS1arMirg eny oNerpmvision, (he sumW the deductbnv provided ln IC G7.1-72 to e mobde fame Naf is 5
rot essessed as ieal property w ro a rrenu/aGUred home Nat is rW essessed es real proparty maY not exceed
one-haH(f2J W Me assessed value o/ Ihe mobde home w manulactured hwne.
SignaWre alAUditnr
Oate signeC (month. Cay. yeaA
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