Homestead_Harris"'" CLAIM FOR HOMESTEAD PROPERTY TAX
s ._ � STANDARD / SUPPLEMENTAL DEDUCTION
Sbte Fortn 5473 (R72 / 6-09)
° � Prescnbed bY we Department of Loml GovemmerR Frmrce
� INSTRUCTIONS: See reverse sitle /or Ning instrvctions.
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JUN 0 2 2011
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��e) ' q' . . certify that I(we) ocwpi aa U I(w� prindpal
place of residence or am (are) buying the following ed real property for which a Homestead Properry�0�i{l��Sc�iod is ereby daimed
under conVact on the date Ihis appliqlion is fileQ (date of filing):
�(We) own ❑ Am (are) buying under recorded conVact �
Am (are) entitled ro occupy as a[enant-stockholder of a cooperative housing corporetion
� Have a beneficial interest in the Wst or the right to occupy ihe property under the terms of a qualified personai residence Wst �
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If Miying m mntraq Fee Simple dwnafs rume
Reoorders otfice where mnvad is recorded Record number Page
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Counry Township iamig ' d(�ify, wn. town.NiP)
IParrnJ number Le9al tlpuiP� Is e proPerty in puestion:
� pmperty ❑ AnnuaCy assesseC rtpbile homc (IC 61.7-n
If any poMidi of the residential sWCW re ar 1he lantl not eaceedtr�g wre (1 J acre Nat ImmeEiately surrourWs that stiuWre is usetl m produce Incame, tlesrnbe Ne use and portion
o,�a���������,a. � �8� o a
a �_Z3-oa� �� � Lf
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CounN TwmshiD CaunN Towrtship
I hereby certify the above statemanfs are We, corred and complete. S .�'"'�": !� , �
/Gw�-. �_
�y�Zo'�`� o� ���sQ`�e�3f- �kSsftid� TN �/76 3`j
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Lane not ezceeding t(one) acrc Immediatey � � ��A`?'��« sr '���o��
surtountlin residential im rovements. � � �
-�^ �'E4�``4..� _ .SF�i.L-a+`-=.?.�
Y��''�T!�"��&
Other land (2) r.�' .TF:�,`�.' ° y
Total lantl (line f plus line � (3) .
Dweliing � (4) �� �'�-�� '�-'�
ResidentlallmprovementsorMnually ��:`•"�'�.FS��3��. s:°.�
Auessed Mobik I Manufacwred Home c'.'Fr�° �._ `>;�i��. _'.
Garage (5) . .i��i ����� ".?,�''rta.
. x3�-.�.;:
.c— ,2_., s ;
Other Improvemenb (6) ;'�,.Y"-7'�.--;H.� r,�s, .;1
7otal Improvemenh (Iine 4 througA line � (7)
Total value (One J phs line n (B) .
I hereby certiy the above is we, correct, Sgna°18 o(�z�55Of �� s'e"� (�1O"�h, �Y 1'��)
and complele.
vaifying acmn - sigriamra otiwmcor oate sqned (rtronm. aar, rT�A
� . . � � � • �
201� pay 20 Lesser o! 60% ot the assessed value of Ne homestead or $45,000
NoMifhcfaMUg any otherprovision. Ne sun W Ihe tleQUCtions prm�idetl in /C 6f.7-72 [o a mob,le home Naf ic $
not assassee as reel properry a Io e menufaCured home Nat b nd assessed as ieel poperry may rrof exceed
onehaM (12) d Ne essessed refue o/Ne mo0ie Iwrtre ormanWactu�ed frome. - �
S' ee of PLd tw ��- Date signea (mmN, da , yEa�