Homestead_Silva"'" CLAIM FOR HOMESTEAD PROPERTY TAX
� � STANDARD/SUPPLEMENTAL DEDUCTION
ir. - State Porm 5473 (Rt2 / 6-09)
S = Presm6ed by ihe Depariment of Lool Govemment Frerce
F ��
I �� FORM '� E
O I HC�iO �
I I �
C T 2 3 2009
INSTRUCTIONS: See reverse side for filing instructions. �
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I(4Ve) I S) o uPi�tl�as mY l��1 P��pPa�
place of residence or am (ar buying the following descrihed real properry for a Homestead Property Tax Standard Deduaion is hereby daimed
under mnVaa on the date ihis appliration is filetl, (date o/filing):
❑ I(We) own ❑ Am (are) buying under recorded conVacl
❑ Am (are) enlitled to occupy as a tenant-srockholder ot a cooperative housing corporefion
� Have a benefidal interest in Ne Wst or the right to occupy ihe properry under the tertns of a qualifled personal residence Wst
•- • •
Name o( daimeni (legal name .
SodalSeamtyrvm�6erofda'viant(
Name of daimant's use (legal name)
Sotial Secunry
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. .-� �
1( buying on conVact, Fee Simple owneYS �ma
RemNefs oftxe where crnt+acf is rcmrdeE Record number Page
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�� Tovmship Ta�d� disiria (uty, fown, t ip)
L�
(cn! number al Aesaip6m,��` Is N rty in weslim:
'f �'��a�—O ��C�� property ❑AnnuaOyassesudmobilehome(ICGf.f-n
�'f arry portion W Ne reselentlal sLUCW re w Ne la�d nW exrPedirg me (1) aue Ihat immediately surtouMS �hat strurIl�re is useE b proCUrc i�ane. descibe Ihe use and portion
f I�e pmperry wT¢ed tn poduce inmme.
• � • • • : � •
Counry Township Caunry Town4up
I hereby cenity ihe above statements are We, cortea and complele. ��d� oi dai ��� '
Pdd2ss (numDe nC street. ary, state. antl ZIP� e)
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, . ., . ,
•- . „..
Land not ezceeding t(one) acre immediatety (�� �?� �.� r}�'`°�s ��'��N� y
sunountlin residential im rovements.
Y�c�r;n�r.Yte•�I[�}2.�h�*c;.�
Other land (2) €`:,`.z.:�°, *Wr `��:�-'
Total land (line 1 plus line � (3)
kvv''p¢�'a..r'J- :.S'u
Dwelling (4) s����irl���,_$��l�`:j-.r;�
Residentlal improvements orAnnualty --:
Assessed Mobile I Manufactured Home Garage ($) � ��-'��';'j }�� �F�� �,.. p'x+�,
7'�` .. _s:� i - {
Other impmvements (6) ' .. _
Total Improvemenb (line 4 throug� Ilna � (7)
Toql vaiue (llne7 plts 1(ne � (8)
I hereby certity ihe above is trve, cortect, Signature otASSessor Date signed (month, day, yea�
and complete.
Vaifying aaon - Signawre of NMitw Date v9netl (rtronth, daY. Yea�
�.-� � � • •
20 _ pay 20 Lesser a( 60% of the assessed value of the homestead or $45,000
NotwilhsfaMirg eny oNer provision, Ne wmW Ne deducObru provided in IC 61.7-f 2 to a mobde lame that is g
rwt assesseE es real properry or (o a menulaCUred hwne Ihat is nof assessed as 2al p�opelly meY ^o� exceed
(1/t) of fhe assessetl rel o e mobde home wmanufaduied home.
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