Homestead_Wilhite"'" CLAIM FOR HOMESTEAD PROPERTY TAX
_ ? STANDARD/SUPPLEMENTALDEDUCTION
= Stale Fortn %73 (R72 / 6-09)
�O / Prewibed by the DepaMrerrt of Lual Goverm�eN Frence
INS7RUCTiONS: See reverse side !or filing instructbna
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� M ' YEAR
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DEL 2 � c���
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�(We) Q��e t�� ���pi� as my (our) prindpal
lace of residence m are bu n lhe followin described real ro Y A� �` �"� �
p ( ) yi g g p perty for which a Homesiead Property Tax Standard Deductlo� is�hereby daimed
under mnVad on th date Uis application is filed, (date ol fifing):
❑ I(We) own ❑ Am (are) buying under recarded wnVact
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperetive housing coryoration
� Have a beneficial interest in the Wst or the right to occupy ihe property under the tertns of a qualified personal residence Wst
•• • •
Name of daimant (kyal name) e � ' .
v�� l�'�
Sadal $epmty nur6tr of daunarrt (ks! h�e ) Drivefs Gcense / Identi5otion / Iswuig State
.
Sodal Securiry numbar of daimanCs spousa (last five dgGS) Dfivers Gcenu / ICPntifxafian / Other num6er Issuing State
of daimarrt's spause (la9 frve dgits)
• ••� �
tl buying on contract, Fce Slmple wmars �wna
Recofdefs otfice wAerc mntrad'a recadeE ' Record num6er Page
..�. - � . �
Counry TownshiD Tamry7 Q�sbict (rity, foxn. townshi0)
Parcal numDer Legal desaiption Is pertym puestion:
� I qoperty ❑ Annw�y essessetl rtqble Fqme (IC &7.7-�
� If any portion W Ne rasidan7al 6hucWfe n Ihe Wnd nol ezceedtrg arre (1) aae that ImmeEiatey wrtourMS that struclura is used m proEUCe inmme, desrnLe Itre use anO poRion
of I�e property wT¢e� lo protlura mmne.
ac�-��-zy- yoa�d a���as
-.- . .: . .
Counry Township Caunry � TowraAip .
I hereby certify the above statemenis are we, cortea and complete. S�wre o imanc �
o � ��� �
Address (number and stleet, dry, 5(ate, aM ZIP code)
8iaa s aso Ff ray�,�� yz
,. , . . ., . ,
�� ..
land not exceeding 1(one) acre immediatety ;;,,`�"`' '� �'9�+.f>a,�Z"��"��s y
aurtoundin residential im rovementt. -y`x—,...
(�� "```��.''.�'�.7^�'-�'.�rt� v;:
Other land (2j ���L:i:`�`u i::`-
Total land (line 1 pWs line � (3) I , ,
ResldenUal improvements orMnually �Iling (4) I � ��;%-�
�#i§:,a,s�3
Assessed Mobile I ManuYachrtetl Home Garage (5� I � ��""�` �
�'�� � �
Olher imp'oveme�rts (6) �� � I
' Tatal Impmvemenb (Ilne 0 Niough line � (7) + � � i
Tofal value (llne 3 pl�c line � (8) I I
I hereby certify the above is true, correct, Sqreture of wssesmr � - I3�
and complete.
Vaityin9 at9m - SSnature ot�tor . � 'a�
�I • • � • � • •
20 pay 20 Lesser of 60% of Ne assessed value of Ne homestead or 545,000
Nolwifhsfaritlug eny Mheipiov'aion, Na sum o/ lhe deducfkns proNded in IC 67./-12 b a mo6i7e hortm Naf B $
not essessed es lael propeM wW a menu(aW�ed home that a raf esseuad as real property may rwt axcee0
one�hatl (f2) olfhe assecsetl rdhce a! Ihe mobde home ormanularfured fpme. '
Signature of Auditor Date signed (monN, day, yea�