Homestead_Reynolds (3)CLAIM FOR HOMESTEAD PROPERTY TAX fORM YEArt
, STANDARD / SUPPLEMENTAL DEDUCTION
S� Y StateFOrm5473(R72/649) , HC10
�O � Pm,scribetl by Ne Depariment af Laml Govemmenl France �
INSTRUCT70NS: See raverse side 7w filing instructions. �! - / / ' / — � _ /J
L `R/
� ' . . .
I(we) cer4fy.0 ied as my (our) prindpal
place o esidence or am (are) buying the following d bed real property tor which a Homestead Property Tax Stand D ction is hereby tlaimed
���uriririnder nVad on Uie date this applindon is filed, (date o/filing)�IBSON C�T�UDITOR
,�7 I(We) own ❑ Am (are) buying under recorded conVact`� ��
�Q Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing co�
� Have a benefiaal interest in the Wst or the right to occupy the property under Ne tertns a qualified personal residence wst
rxmtel
Name ot daimanYs spouse (lega/ neme)
If buymg om m�trad, Fee Simple ownets `ama
Recordefs affmc where mntraG u remdeE
Caunry 7mmship
Drivelsikenselldentifiration/
of tlaimant (last fiva d'giLSJ
af daimam's spouse (lasl (rve dgASJ
, b . ��
PaRel number Q� 9al tlrsaiptian �
a�-i -� i -�� �
�tt any portbn d the msiAentlal strucWra or Ihe IaM not axceed4g ona (1) aae Ihat i
o,�,e��m������,�. //-3—iv
�
��
Tovmship
I hereby certiTy the above statements are We, corteU and complete.
AdYfC65 (number antl ahaef, dly, stPte,
iC -i � „ .. � - � �.
Land
acre immediately
Otherland
Total land (line 1 plusline �
Residential improvemenb or Mnually �Iling
Auessetl Mobile I Manutactured Home Garage
Other improvemerrts
Toql improvemen� (Ilne 1 Nioug� llne 6)
Total value (line J p!(a I/ne 7)
I hereby certify the above is nve, correct,
and wmplete. -
Vaifyirg ac6on - SignaNre ot/uiCtw '
�2)
(3)
(4)
(5)
��)
(B)
sqnatura arASSessor
number
Retad number � Page
Tam�g disbia (rity,
Is Ne properry m question:
I��� w�cenr LJ n��cy �ee �,auie n� pc ��. i-,
idlately su�mun Nat shucNra is used to pmduca Inmme, desrnba Ne use anO portion
�. oa S
20 pay 20 _ Lesser of 60% of the assessed value of Ne homestead or 545,000
NdwGhslaMi�9 anY o(herPrO�i.tim, ihe sum o/!he dedlsliOn3 D� in IC G7.1-fYln a rtroDOe Irome Nat is $
not assessed az realproperry w b e mefuAamred hane Nat 'a not essessed as real property mey rwf exceed
one��haM(12J o/Ne assessed value d Ure mobde home or manu/adured Irome.
SignaWre otAUditw �
oate signed (rtronth. daY• Y��)