Homestead_Vaughn�`"'" CLAIM FOR HOMESTEAD PROPERTY TAX
_ s STANDARD/SUPPLEMENTAL DEDUCTION
� Stata Fortn 5473 (R72 / 6-09)
S : Preun�etl by Ne Departmenl of Lo�l Gwerrvrient France
INSTRUCTIONS: See raverse side for filing instrucfions.
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�(4Ve) (/ certiry that I(we) occupied as my (our) prindpal
place of residence or am (are) buying th ollowing described property for which a Homestead Pmperty Tax Standard Deduction is hereby daimed
unde� mnVact on the date this applicaUon is filed, (date olfiling):
❑ I(We) own ❑ Am (are) buying under recorded wnVact
❑ Am (are) entltled to occupy as a tenant-stockholder of a coope2live housing corporation
❑ Have a benefidal interest in ihe wst or the right to occupy the pmperry under Ne terms of a qualified pereonal residence wst
v,
Sodal Sewriry number o1 tla'unanl's spouse (lasl frve
II buying on contraci, Fee Simple ownefs reme
Remrdets afice where tontrdcl is recorded
Caunry
number
o( da'unant (WSf (rve
Drivers license / ICentiSfafian / Other number
of daimanCs spouse (W9 frve dgzs)
Tawg d�sviri (rify, Nvm. townshiD)
Issuing S1ate ��
Issu'vig State
Record number Paqe
Parcd number Le9al descnDlion �Q. �l� /� L Is Iphe (WoP�Y in Weslion:
5 N E ��' 3�•, � � �J Reai pmperty ❑ AnnuaOy assessed rtnMle home (IC 6f.1-
If any portion ot Ihe residential sWCW�e w Ne IaM not ezceedi�g a�e (1) aae that immetliately surtounds Iha[ swmre is useC m praduce Income, desaibe lhe usa aM portion
of U�e P�PaKY �� � P�uce inmme. �
0�6-19-/5�- a-oo- O°a.�sv-oois
Coumy
Township
I hereby certify ihe above statements are We, cortect and complete.
AAAress (numbe/ entl9reef, dry, sfate, a�W LPCOde)
LanA not ezceeding 1
Otherland
Total land (line 1 plus line 2)
acre immediatety
Residentlal improvement5 or Mnualty �elling
Assessed Mobile I Manufactured Home Garage
Other improvemenb
Tofal improvemenb (llne d Nrough line 6)
Total value (llne 7 phs llne 7)
I hereby certify the above is true, corted,
and complete.
Vaitying action - Sigrayre of Niditw
�2)
(3)
(4)
(5)
(6)
�)
(B)
Sig�aLUe af Assessor
Caunry
20 pay 20 Lesser of 60% of the assessed vaiue o/ the homestead or $45,000
rMtwi(AStaMin9 eny otherpmvivrn, Ne sum o! ihe tletlucfions provnfed in IC bf. f-77 m a mob0e hane Nat is
rot assessed es ieel properry w to a manufartured frome Nat a mt assessed as ieal propeM �Y �t esceetl
4
signeE (mrnN. aaY. YHaA
Date sgned (rtronN, Eay, yea�
Signawre ot AuOitw ,� _� I Date signed (month. Cay,