Homestead_Bryant�
CLAIM FOR HOMESTEAD PROPERTY TAX
rt ?; STANDARD / SUPPLEMENTAL DEDUCTION
S:: .�Y StatB Form 5473 (R12 / 6-09)
�� � PtesctiDetl by Ure DepartmaM at Loml GavemmeM F�nce
INSTRUCTIONS: See raverse side /or filirg insUVC(ions.
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APR `L 0 20'2
I(We) �-- WWUN `�' cen�ivr t�hqact l(wel°�}� ��UDITifKrindPal
place ot residence or a(are) buying Ne following described p perty tw ich a Homestead Property 7'6x'S1a��aMUedudion is hereby daimed
under contrad on Ihe date Ihis appliq6on is filed, (date o(filing):
❑ I(We) own ❑ Am (are) buying under recorded mntraa �
❑ Am (are) entltled ro occupy as a tenant-stockholder ot a cooperative housing corporetion
� Have a beneficial interest in ihe wst or the right to occupy ihe property under the terms of a qualified personal residence Wst
Narne ol deanpni's spouse
If Euying on contrad, Fee Slmple ownefs nama
Reoor0er5 ofice where mntred is n.mded
. (p -'� �j � �`f'� `fUJ "DObI
�tl any portion W Ne residential sWCOire ar Ne land
u� me wuaem w�m m a�oe„m �,�.
�
Caunry
Township
I hereby certify the above ste[emenis are We, cortect arM mmplete.
lana
(num6er aM stree(, dry, ststa, antl ZlPOOtle)
acre
Otherland
Tofal land (line 1 plus line 1)
Drvelling
Garage
Other ImO�`Rmefrts
ToUI improvemen� (Ilne I Nroug� Ilne �
Total value (//ne 3 p/�s !!ne �
1 hereby certify tha above is We, correct,
and wmplete.
laifyi�g acbm - Sig�nire of PuQtar �
Ta�mq
�hatunrnBEiately
� NCG. 1- /ll
�
(�)
(Z)
(3)
(4)
(5)
(6)
�%)
(8)
Sigratura of Assessor
Counry
20 _ pay 20 Lesser of 60% ot Ne assessed value of lhe homestead or $45,000
NoM1vi(hsfarMing eny oNer provision, Ne sum o/ the deductiwAS proriCetl in IC 61.1-12 ta a rtrobde Iwme (�af is
rwt essessed as iael property a fo a menuFaGUred home Nat is rrot assessed as real p�opeM �Y �1 exceed
onefiaM/121 d Ne assessed valueW Na mobHe home or manutdrtured home.
Recad numbu
fownchip)
Page
quaUOn:
erty ❑ Annua�y assessetl moWe hwne (IC 61.1-:
ra k used ro P�uce Lxome. Oescn'ba �he use aM portim
S
Townstup
Date signetl (rtronfh. daY• 3'��
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