Homestead_Mosby�'"' CLAIM FOR HOMESTEAD PROPERTY TAX
s __ � STANDARD / SUPPLEMENTAL DEDUCTION
State Po!m 5473 (R72 / 6-09)
•S I p�¢�y� yy �¢ Department of Lmal Gwemment Firence
INSTRUCTIONS: See reverse side /or filing insfruc�ions.
V"` �
" � -�/ YEAR
0
SEP - 3 2009
��y,�e� � ��� � 'h' that 1(we) oceGpre6
pla f residence or am (are) buying the following desaibed real prope r which a omestea Prop rty 7ax S1aBj�d��ft� '+�^
un e� conVact on the date Nis appiiratlon is fiied, (dafe oI filing):
I(We) ovm ❑ Am (are) buying under recorded conVacl
❑ Am (are) entilled [o occupy as a tenant-stockholder of a cooperalive housing corpora[ion
� Have a benefidal in[erest in �he Wst or the right W occupy the property under ihe tertns of a quali(etl personal residence Wst
��
Page
�ooeny U AnnwP� assessetl rtnd'le home (IC &1.1-7)
�ucW2 is useG m Woduce i�orne, descnbe the usa and ponion
20 _ pay 20 Lesser oF 60% of the assessed value o(1he homes[ead or 545,000
NWuNhslaMing any otherprovision, Ne sum dthe detluctbns pmv�tled in IC bf. f-12 fo e rtnWle home Naf is 5
rqt assessedy�s real pmperry w lo e menule�tured home Nat is rwt assessed as ieal property may rot ezceed
TownsNp
Date sgned (mrnth, day, yea�
(rtronN. daY� 1'��)
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