Homestead_LameyCLAIM FOR HOMESTEAD PROPERTY TAX
i_rt 4 STANDARD / SUPPLEMENTAL DEDUCTION
StatB Fortn 5473 (R72 / 609)
�O � Prascnbetl M Ne DepanmeN of Lool GovemmeN Frence
INSTRUCTIONS: See raverse side for fifing instructions.
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YEAR
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� (�'�e) , . Olep�lpfd3�as my (our) prindpal
place ot residence or am (are) buying the following described real property for ich a Homestead Property Tax Standard Ded_uUion is hereby daimed
under mnVact on Ne date this application is filed, .(date olfiling):
❑ I(We) own ❑ Am (are) buying under recorded conVact
❑ Am (are) entitled to occupy as a tenant-stockholder of a coope2tive housing corporation
� Have a benefiGal interest in the wst or Ihe right to occupy the property under the terms of a qualified personal residence Wst
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If buying rn mnn'acl Fee Simple owneYS r�ame
Recordefs oRice where mnVaq u recoideO , Remrd numbu Page
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���y TownShip Taxitg Ei 'tt (rity, Ipxn, (pwnship
Parcel number Legai descripibn �? • d'10 /'� � Is ihe
mp�mpertym W�tion:
� Sw -3 S- -3 -// +�nea� wvvem ❑ rw,�aBy essessea momc nome (�c 6�. �-n
11 any portion of Na residential sW�re w Ne WM not exreedG�g are (1) aae Ihat immetliateJy surmunds Nat sWC¢ira ¢ used tu p�oCUCe Income, Eesrnba the usa and porlion
or Ne v�aem � m w�uce mcome.
ab-l8- 35-aeo- ooa. y a9-o a.v
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Counry TownshiD CoumY � Trnttahip
I hereby certify the above ststements are We, correu and complete. at �i t �
ress� ber arM stree; dry, stata, and L� e) � �`
lN Vll w J
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sunou�m; rn,�sidmtiel irtm) rovemen�diatety ��� `� +�r, ;i .�=a�¢�� ��
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Other land (2) ����? ���,
Total land (line 1 plus line 1) (3) �
Dwelling (4) . =+�'a-rr �4`_'�-'�� ��
Residential improvements orAnnualty 1=:°is�..-.3�.- �.�� ±ets.,.���..:s:h
Assessetl Mobik / ManufaGUred Homa Gare e F,S�idw ax � ;i l'+rik'�F
g �5) , ;�' 's a'3�a`�,.�c�y:k`a�a
s? .-sa,,.+taF..c.._.+�. ,c
Other improvemerro (6) � ��,*��4��. �A`�
�`.? r'�+i�a �
Tofal improvemen6 (Ilne 1 througAline � (7)
Tofal value (llne 3 plus line � (g)
I hereby Certify Ne above is we, cortea, Sigriawre of wssessor Date signea (montn, tlay, year)
and complete. .
VeityW�9 adian - SignaW2 of AuQitar � Date vgned (monN. tlaY. Y��
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20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000 '
NoMdhstaMirg any aGrerprovis'pn, !he sum oI the detlurlinns proHded in IC E7. f-72 b a mobile home Nat is $
not essesmd as real poperry or fo a rrenufartured fmrie Nat a not essessed as real properry may not ercaed
oriehsH(121 a Ne assesse0 value d Na mobJe wmanufarYUrad hmre. �
5�8 o(Pndrtor ' ' Date si9ned (monlh. daY. iTa�