Homestead_Dutkiewics"'" CLAIM FOR HOMESTEAD PROPERTY TAX
, z STANDARD / SUPPLEMENTAL DEDUCTION
`' � State Partn 5973 (R72 / 6-09)
�� = PresuiCed by the Department of Local Govemment Firiance
�NSTRUCTIONS: See raverse side for filing instnictbns.
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AUG 2 S 2009
1(We) � %% (���v/ � � cerlify �B�+Qiid'ac��@iTa� rily�o�rynndpal
place of residence or am (are) buyi following described al ropeAy for which a Homest Pro e Tax Sfandard Dedudion is hereby daimed
under conVaA on the date this appli ' n is filed, (dale o(filing):
❑ I(We) ovm ❑ Am (are) huying under recorded wnVact
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperetive housing corpo2tion
� Have a beneficial interest in ihe Wst or the right to occupy the property under the tertns of a qualified personal residence Wst
Name
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Record numCer Page
ri (riry, • � shi )
Is She ProPeM in W estion:
�� 7 J IlrtJc� i vrocerry U AnnuaOy assessed mobile hane GC 61.7-n
It any portian of Ne revdential sWCW re w Ne Ia�M nol exceeEirg one (1 a that imme0iatety surrourias t swaure is usea to praduce imnrne, Eescnbe the use a� porcion
of Ne PraPertY uti¢ed to P�uce income. � � /+ � (� � ' � ',V a • O !, �- �
G
Counry
Trnmship
1 hereby certiry the above statemenis are W e, correU and complete.
s�ere,
Land not exceeding 7(one) acre immediatey
Otherland
Total land (line 7 plus line 2)
Dwelling
ResidenUal improvements or Mnualty
0.ssessed Mobik I Manufacturetl Hana Garepe
Other imOrovements
Total improvemen� (line 0 thio�gh line bj
Tofal value (line 3 phs Ilne n
1 hereby certify ihe above is true, cortect,
and complete.
Vailyi� acoon - Signawre of fwdiw
(�)
(2)
(3)
(4)
(5)
(6)
��)
(8)
SlgriaLna of Auessor
Caunry
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20 pay 20 _ Lesser of 60% of Ihe assessed value of �he homestead or $45,000
No1wfI1�51aM�ug enY a�erP�h��. Ihe sum of Ure dedurliwis porided in IC 6f.1-f1 fo a mob�7e Mme lhaf is
rwt assessed es raal pmperry ar fo a manufaUUretl home Mat is rof assessed as real properry mey not exceed
�no-nalf /1//ii�flne acw.c<M vdlue�Ne /�6bde home or manu/aQUmd home.
5
Township
Date signed (rtronN. tlay.lT.a�
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