Homestead_Boeglin (2)�`"'" CLAIM FOR HOMESTEAD PROPERTY TAX
g � STANDARD/SUPPLEMENTALDEDUCTION
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State Farm 5473 (R12 / 6-09)
�O l Presaibed hy the Departmenl of Lo�l Gwemment F�nte
INSTRUCTIONS: See ra_verse side for filing instructions.
FORM
HC70
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♦
�(yye� V�' � V/ �/�l.( /!��(%� �`"� cer�at g,�� &.�b�ed as my (our) prindpa�
place o( residence or am r) buying Ihe following described real properry (or a Homesiead Property Tax SYandard Deduction is here6y daimed
under contract on ihe date is applipGon is filed, (date o/filing): -��7 �
❑ I(We) own ❑ Am (are) buying under recorded contract O"`� AUp�TpR
❑ Am (are) enUtled to occupy as a tenanFStockholder of a cooperative housing corporation f�q SON COUNTY
� Have a benefidai interest in �he Wst or the right to occupy the pmperty under the tertns of a qi72�Tied pereonal residence Wst
number I Page
(/` U" ��' l f �(/'�/./�J(J—Ll� � �Real property U MnuaDy assessed mohile home (IC 61.1-
If any portlon of Ihe resCential swcWre or Ne IarW not erceeding rne (1) aue that immeCiatety surtounCS that swcNra is used to pmduce inoome, desrnbe iha use and portion
of ihe pioperry unT¢ed m poduce inmme.
County
Twmship
I hereby ceNty the above sfatements are we, correct and complete.
Adtlress
Land not exceeding 1(one) acre
Otherlantl
7otal land (line f plus line �
ResidenUal improvements or Mnualty �e11ing
Assessetl Mobik 1 Manufactured Hane Garage
Other improvements
Total Improvements (line 4 fhrougAline �
Total value (line 3 pl�s I/ne 7)
1 hereby certify lhe above is true, correct,
and complete.
/aifying acuon - Sigrenna ot Auditor
(�)
iz)
(<)
(5)
(6)
(�)
(8)
SigriaL�re af Assessor
Caunry
20 _ pay 20 _ Lesser o( 60% of the assessed value of the homestead or 545,000
NMMlhslanding any otherproNSion, Me sum ol the tleCUCtions providetl in IC G7.1-1P to e rtnb�e home Ihat is $
not essessed as real property w fo a rrenutaUUred home fhaf is not assessed as real pmperty maY �� erceed
ana-haH /1/M3/Ne assessed value aLt4e mo1�B'fi�e or rtanutarlureJ froma.
Township
(month, day, }rea�
Date signed (monN, Oay, yea�