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Homestead_Zenthoefer\-J
"'" CLAIM FOR HOMESTEAD PROPERTY TAX
i _ '; STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R72 / 6-09)
�O � Presuibetl by the Departmeril at Local Govemmarit F�nce
INSTRUCTIONS: See raverse side lor filirg ins7ruUions.
/ Q�/vi'c-'c-i
�L(.)
�' ��'_ ;'J �'
:�,
MAY 19 2011
� M�e) �' � � ceGA�iTy that I(we) ox��<
place of re dence or am (arej buying the following escribed I propeAy for which omestead Propert�Q$.fk6�@p��uk'hoLv�
under G on ihe date Ihis applicaGon is filed, (tlate o/filrn UUI
9)
�I (We) own ❑ Am (are) buying under recorded conVacc .
Am (are) enGtled to occupy as a tenanbstockholder of a cooperative housing corporalion
� Have a beneficial interesi in Ihe Wst or the right m occupy the properry under Ne tertns of a qualified personal residence Wst
Name of tlatrmypCs spousa
SodalSenuiy mimber
tl Wyuig m coniracl, F¢e Simple ownefs rume
Recorde�s of6ce where oontrad is mmded
Counry rownship
Omm.rs Iknnse / Identifcation / Othu number
of tlaimant (las( rive digds) �
at daimanfs spouse (las! five dqiGS)
(our) prindpal.
�reby daimed
� ���9 �,a�N
Reowd number Pa9e
Ta�atg dtstricl (City, town,
ParcrJ number Legal desmiption . Is Ne pmperty in Question:
� �' � ��� �. � 9. � ❑ Rra� P�VenY ❑ MnuaOy essesseE moG'le lome (IC 6-f.f-7)
II arry ponion of Ne resiAenllal sWCture or ttre IarW noc exreatling rne (1) aae Ihai immediatey surmunds that swmre is used to produca Inoome, Oescnbe Na use and ponion
oi Ne pmperty utl6ze0 to P�uca in�ort�e. •
a�-�4 -Z �- z o0 oo a. a5 �-oa.5
Counry
Township
I hereby certify Me above ststemenis are We, corteU and complete.
Ae\� (rwmDn� �� t, ary� (e, an0o O
.- .
Land not ezceMing 1(one) acre immediately
surtounding resitlendal improvements.
Otherland '
Total land (line 1 plus line �
Residential Improvemenb or M
Ats�setl Mobile / Manufach�red
Other Improvemerrts
Dwelling
Garege
Total ImO��emenis (line I Niough line �
Topl value (Ilne 3 pl�a 17ne 7)
I hereby [ertiy ihe above is We, cortect,
and wmplete.
va;tying aaan - signamie ot a,6cor
�2)
(3)
(<)
(5)
(6)
�)
(8)
Sgruture of Assessor
Caunry
20 _ pay 20 _ Lesser of 60% of the assessed value of the homes[ead or S45.OW
NduilhVaridug eny o(herprovision, the wm o7the deduclions provided in IC 67. f-77 ro a rtrob�b Mme Naf a $
not essessed as real properry or ro a manNecfured hortie Ma( a not assessed as real property mey rqt erceed
wrefiatl (12) d Ne axsessee value W Na rtp6de fwme ormenNactured hwnc.
Signature of Auditw
�f7��y
Date signed (monlh, daY. Y��)
