Homestead_Emmons"" CLAIM FOR HOMESTEAD PROPERTY TAX
i _ STANDARD / SUPPLEMENTAL DEDUCTION
State Fwm 5473 (R72 / 6-09)
� � PreunbeE by Ne Department W Local Govermnent Frmixs
� INSTRUCTIONS: See reverse side !or filing instnictfons.
�H�I OL EAR
JUL 2 5 2011
, �,e> .:
ce"�,'G��3't�E�b'e'�
place of residence or are) buying Ihe following described real properry tor which a Homestead Property Tax Standard Deduaion
,u�n,de�r conVaa on Ihe date Ihis apPlinlion is filed, (date of fi/ing):
L4'� M'e) rnm ❑!vn (are) buying under recorded contract
❑ Am (are) entiUed to occupy as a tenant-stockholEer of a cooperative housing corporelion
� Have a beneficial interest in lhe wsl or the right to occupy Ihe pmperty under the tertns of a qualified personal residence Wst
e;e�s�
tl dryv�g on cantract, Fee Simple awneYS �ume
Rem`deh af6ce where oont2p is rem'ded
Counry � iownship
If any
ot Ne
Colll�iy
w aah,an (lau rnre
Issuing
orrvers rca�e i iee�ur�aon i omE
a1 daimafrt's spouse (/est five dqits)
Recad numher
d�ma �rsy, ro�.,�,
�� /� /�/�/�/� �egai /ae�s�rnpCron Is Ue VmPertY in question:
NVV �WV J i10� �7 ❑�� P�DPrtY ❑��eDY assessed mobde home (IC 61 7
of Na residentlal sUUCWre or Ne WM not exceeELg pre (1) acre Nat MmeEWtely sunounds Na[ str�MUre La usetl W poduce income, Eesalha the use and pwtion
y utmzad tn pmduce incortre.
Tamship
I hereby certify Ne above statements are We, cortect and complete.
Land
Olher land
ToGI land (line 1 plus line �
enOLPooCe)
acn Immediatey
ResldentlallmprovemenborMnualy �����9
e• � ed Mobile I ManufactureA Home Garage
Othu improvemencs
Total improvements (/ine I fhrougA Ilne �
Total value llina 3 plus line n
I hereby certify ihe above is true, correct,
and eomplete.
Vailying amon - Sigru:ure of N#itor
(�)
iz)
(3)
(4)
(5)
(6)
(B)
Sig�unne of Pssessar
20 _ pay 20 lesser of 60% of the assessed value o� ihe homestead or $45,000
NoMifhstand'ug eny a(hei pmNSion. Ne wm ol fhe ded�.ctlont provrded in IC 6-1, f-71 to a mobde home Ihaf is
ToxTSNp
'.`.
Date signeG (mont�, tlay, yea�
Date signed (month, Eay, yea�
$