Homestead_Kiesel (13)"'" CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD/SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R72 / 6-09)
�O � Preuribed by Ihe Departmerrt of Laal Govemme�rt Frefxe
INSTRUCTIONS: See reverse side forfil"ug inshuUions.
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SEP 1 6 �utu
� • � .
�(�'e) � � SOPIe afj�4ii�t I�we7��pieRd as my (our) prindpal
place of residence or am (are) buying the following desuibed real property for which a Homestead Property 7as Standard Dedudion is hereby daimed
under conUact on �he date this applintion is file4 � (date of filing):
❑ I(We) own ❑ Am (are) buying under recorded conVact
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperetive housing corporation
� Have a benefidal interest in ihe Wst or the right lo occupy ihe property under the terms of a q�alified personal residence Wst
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11 bu�Nig om m�tratl, Fee Simple ownefs riame
Remrders affice where mntrad is recaded � Record numb� Page
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Counry Towns�ip Ta�mig tlisbid (city . Mwnship) .
�1U..i,d�tiJ
Pa�J numher al desa�iapti`m ` Is Ne pro in quettion:
' }" C... l,(� �-�' � � I. q ❑ Real property ❑ Mnua�y assessed rtrobile home (IC 6f. f-n
�It any pONbn of Iha residential swcWre or Ne W W not exceedi�q orre (t ) aQe Nat immBtliately SUrtoUrlds that stnrc�re is uSeE to produca inmme. aestxiba Ne use and portion
ot the P�PeM u�T¢eL m potlum inmme.
ac�_z2-o�-Z�_«�a.� s a-oay
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Cowriy Toanship Counry Tmn�ship
I hereby certify the above ststements are we, cortect arM complete. S�1°i �""a"� � �
�_
ress (number an0 sfree; cHy; afate, and LPCOda)
1 S
, . .� . �
.- .
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LanE nol ezceeding 1(one) ecre immediately - ��� � f`"`� ��"�s`�°
surtowMin resltlential im rovements. (� � �°"""' `���' is�
rA- §;� `°`s': �.._ �'2�ks��-�.-X
Otherland (2) ��'"�����'}� • .
Total land (line f plus line 1) (3)
. �.�.� i �. _ - +.e=-,x � �: r,�a�.,.,, � :� �yr�,.=, ��p
ResldentlallmprovementaorMnualy ��ling � (4) �.,,,_�'�-������.Y,�,�a.�x,�,'
/lssessed Mobile / Manu(actured Homa Garage 5 � �' : O 1 �U �-s-�C' ��" `�`�w-`L7�'�'"
� � � ,k��.�.}r.�1+5.�4^.��'.•��YRS?it}�
�: -�T�;�,::=�;'.,
Other improvements (6) ;�,a�,� ief � =� ;
v
Tofal improvemenb (llne 1 thraugh Ilne � ,(7) _ �� ,_
7od1 value ��line7 pl�a line n (8j Gi'= =`� --'«NTY I Uti
LyNTY
I hereby certiy the above is We, correa, Sigratura ofnssessar Da;e sgned (monrh, day, yPa� �
and wmplete. • �
Veri(ying acGOn - SignaWre of PLdita . Date signed (monN, day, yenr)
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20 pay 20 _ Lesser o( 60% of the assessed value o/ the homeslead or $45,000
NWwvhsfaMUg any oNerprovision. Ne sum W Ihe deductions prm�d.�d in IC 67.1-12 to a mob�e frortie Nat b $
no[ essescetl as real popeily or fo a manufactureU Mme Nat k raf essessed es real propeAy mey nof exceeC
one-heH (7/I) W Ne assesse0 rd/ue d Ne moW7e home wmanulamired fprtie.
Sigrutuee of Audifw ' Date sigrreE (manfh, OaY. Y��
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