Homestead_McGrewC
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CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD/SUPPLEMENTAL DEDUCTION
S Stata Fortn 5473 (R72 / 609)
�� � Prewihed by Ne Deparimenl of Lo�l GovemmeM Fnaxe
o?o/� p��o�a
FORM YEAR
HC10 �
INSTRUCTIONS: See 2verse side for fifing instnictions. "
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�(�^�e) certify that I(we) ocmot� a�m76(o�4}�p{�dpal
lace of residence or am are b UG i.
p ( ) uying the (ollowi described I property tor which a Homestead Pmperty 7az Standard Dedudion is hereby daimed
,u.�nd/er�o nVaG on ihe date this applic�alion is filed, (date of filing): `''yy/ �
� I(V✓e) own ❑ Am (are) buying under recorded conVaa p'( 4'a. �,�'�°ijr
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❑ Am (are) entitled to occtipy as a tenanas[ockholder of a cooperative housing corporetion �� flgON COUNTY AUDITOR
� Have a beneficiai interest in the Wst or the right to ocwpy the pmperty under the terms ot a quafified persona res�dence Wst
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tl bryvig rn mntraq Fee Simpie ownnYS riame '
Recordefs M4ce where contrad is mfn�ded � Recdd numbu Page
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Caunry To.vnship Ta�m�p disvia (rilY. Nrn. townxhiP)
=J��rt=ber �_ �• I tlescriD � Is N❑e pm�perry� tion: ❑ MnuaOy assessetl rtwWe home (IC 6f.1-7)
,If any porUon of Ne resdentlal swmre w the IaM not exceedu�g rox (7 ) aae Ihat Mmedlately wrtoufMS Ihat sWCGna is used to produce i`rom�e, tlesmbe Ure use and portion
��a��������� ,� � aa
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Caunry Township Counry Twrt�sAip
I hereby certify the above stetemenis are We, cortect aM complete. 5 tu imant �
C
r
res (numberaMs7reet,riy,slate,aMZlPcade)
i G oo v/ cT. H v�sr� . 6 3
, ,. , . . ., . .
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Land not exceeding 1(one) acre Immedlatey ;�; „�s,�`!{��y- �'F�-�`��
surtoundin residentialim rovements. (�) c;,^.�F,�'�y%�i.i.�,�`-`'- z-�.,i.>�`
f. 't�."a�t' : `th
OthetlanA (2) ,��f;{hz.;;�?,_.�,,.��.�',�i' �
Total land (line 1 plus line � (3)
9 i ) � � t*� y�'a.y�.�-.,.�.7^�..'S�rTY�"�`fi+��s,�sw
ResldentiallmpmvemenborMnualty �Ilin 4 '�� =-� y�},�.�tw
Assessed Mobtle I Manufachired Home 9 z-. Y.�'SL°£'tic� "�#���iir,f.�.
Garz e (5) ,�`v'.�'�'.`..'4.a�.x.,��."�� �i.i'v:.y
�;�;r_. r. --: ;�.�� .
Other imProvemeMS (6) �y�'F.'�3�'r��
Tofal improvements (Ilne 4 Nroughline � (7)
Total value (Ilne 3 pl�a line 7) (8)
I hereby certify the above is true, wrtect, Sig�wre ol0.ssassor oate signetl (monfn, Cay, year)
and complete. . - .
Vailyirg acYmn - SigriaW re ofluiditnr Date signetl (rtanN, Eay, yea�
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20 pay 20 _ Lesser of 60% ot ihe assessed vAue of the homeslead or $45,000
NoMilhtfaMeg eny otherproVision. Ne sumW the deAUrfkvtt pro�ided in IC Sf.7-12 ta a mobQe hwne Nat fs $
rw assexsea as rea� ploperty or ro a manufac�red nome tliei s nor esseued as rea�woaem rney nor exraed
onehaM(12J d Ne assessetl rdfueWlhe mo6de hwrm ormanularlured frortie.
Signature of Pudiiw Date signeE (monfh. CaY. Y��