Homestead_Lamey (25)� ._^," CLAIM FOR HOMESTEAD PROPERTY T
= STANDARD / SUPPLEMENTAL DEDUCTIO
Stale Fortn 5473 (R72 / 609)
�� ,�„ � Prescribed by Ihe Departmenl of Lo�l Government Fna�e
INSTRUCTIONS: See reverse side farliing instructions.
N �O� Fo�TiULY E TER��ON
� �eF,�ct Io inal a ceptance ior ians(er
� \ _ ay of _
//'ll/-�-e�, �/� Auditor
CWn�i
I(We) l certiry that I(Gk�1c6,'= ^_ �(puq ��,�__�
place of sidence or am (are) buying ihe following desaibed real property for whi a Homestead Pmperry 7ax Standard Dedudion is hereby daimed
under p on the date Ihis applipUon is (led, (date oflling):
(We) own ❑ Am (are) buying under recorded conVact
] Am (are) en6tled to occupy as a tenant-stockholder of a coope2tive housing corporation
� Have a beneficial interest in the Wst or the right to occupy Ihe property under ihe tertns of a qualified personal residence Wst
(
Reoord number � Page
'�l"'I Ol'J �/V —WOC• 1>(� �lJo�Y I LJ R�i wov�ny U AnnuaDy assessed mobile home (IC 67. t-
If any portiu� 01 Ne resitlentlal swcWre or Na WM nol ezceedGg one (1) aae [hat immetlia[ety surtwnds Nat swmre is usetl m pmduce Im�ne, desaibe �he use aM partion
of Ne propefty u0T¢ed to p�o0ure inmme.
P-��.�-�a-4-i� i.a��
Township
1 hereby certify Ne above statemenis are we, cortect and complete.
ss (number arM sfreet, ary, stafe, end ZI,P`w�e)
� ti S /.s 1% 1
. .. .
Land not exceeding 1(one) acre immetliatety
surtounding residential improvements.
Otherlantl
Total land (line 1 plus line 2)
ResldentlallmprovementsorMnually �����9
Assessetl Mobile I Manufactured Home Garsge
Other improvemenis
Total improvemens (line 1 thmugh Nne �
Todl value (Ilne 3 pl�s llne n
I herehy certity the above is true, cortect,
and complete.
Veriying action - Signawre o( Auditw
��)
i2)
(3)
(4)
(5)
(6)
i�)
�B)
Sigriawre of Assessar
Counry
20 pay 20 _ Lesser of 60% of the assessed value ot 1he homestead or $45.000
NMaiNStardirg any oMerprovision. Ne sum o( Ne dedurlionc provitlr,d /n IC 6-f.1-12 ta a mo62e home Nat is
rot assassad as real popeiry or fo a menufartured hortie that is rot essessed as reel pmperty meY ^ot erceetl
onehaHlf21 N the assessed value a/ fhe mobile �ome wmanWaUUred home.
5
Townslilp
Da:e signed (rt�rnth, eay, �ear)
Date signeC (rtron7h,
o(AUditnr I Date signed (monih. daY. YeaA