Homestead_Maxam�
"' CLAIM FOR HOMESTEAD PROPERTY TAX
i,.__ ± STANDARD / SUPPLEMENTAL DEDUCTION
Sbte Fortn 5473 (R72 / 6-09)
�O � Prescnbetl by Ne Departmen� 01 Loral Govemment Frerrce
INSTRUCTIONS: See reversa side lor (Jing instrucfions.
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NOV 0 6 2009
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1(We) � as my (our) prindpal
place of r, ence or a are) buying Ne tollowing de "bed real property for which a Homestea mperry Tax Standard Deducdon is hereby daimed
under conVact on the date ihis appliralion is file4 (date o/filing):
❑ 1(We) own � ❑ Am (are) buying under recorded conVact
❑ Am (are) enlilled to occupy as a tenant-stockholder of a cooperetive housing corporation
� Have a benefidal interest in �he Wst ot Ne right to occupy ihe property under [he tertns of a qualified personal residence Wst
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11 buying am m�baQ Fce Simple ownefs name
RemrOers ofice where mntraG is recortleC Record number Page
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���, Township Tax'vig disiria (riry, rown, rownship)
� ��� •�� Legal de�'ption Is N❑e p�operty in Weslion:
ol Y �� P�VenY ❑ Annua%essessed rtndle home (IC 51.1-7)
�tl a�ry portion of Ne re9dential strucWie w Ne IaM nal exceedug me (1) aoe Nat immediately SurtwMS that 6WCNre is used to pfoCUm ufcome, dewiGa �he use a`d portion
of Ihe pmperty uoTaeC m proEUCe inmme. �O
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County 7ownshiP CaunN Township
I hereby certify the above statements are W e, corzect and complete. �R ��iman� �
V`'l.
Pddreu( be+antlstieet, - ,s�afe entlLPtade) �(Z6 3
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Land not exceeding 1(one) acre Immediatety �� �'�"'L ��i ��;:,;
surtoundin residenEal im rovements. (�) � `'�= �+ �'��s=-•
Other lantl (2) '.� . � -.
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Total land (line 1 plus line Z) (3) f- -t �`
Dwellin9 (4) �c.=. �c� � � ^, ., I �i�'i�
Residentlal Improvemenfs or Mnualty : '_,
Auessed Mobile / Manufactured Home ' �y." � �� `'`.
Garage (5) I ,_�` �m/� I.O 4c:F�;�A:
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Otherimprovemenb (6) �i . . ,-
Tofal Improvements (Ilne 4 NrougD line fi) (7) 6 � •� `
Total value (llne 3 plis I/ne � (8)
I hereby certiry the above is we, correct, S'�"'�"� °�'�0u0f ��e �� (��• day, yea�
and complete.
Vailyin� adim - Sigfay2 o(Auditor Date signeE (monN, day, yea�
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20 _ pay 20 Lesser of 60% of Ne assessed value of the homestead or $45,000
NWwilhstaM6g eny oMerprovision, Ne sum d Ihe deductiunc prooitledln IC 61.1-77 ro a rt�obde fame Nef B 5
rot essessed es �aal P�PeN3' or ro a marudacmrad hrnie Nat is not assessed es rael proGeKY maY rot erraed
aneJ�atl (72) o! Ne assessed rd/ue of Na mob�e fwma wmanNarluretl froma.
S9naWre W Putlltor Date si9ne0 (monfi. daY.1'ea+)