Homestead_Otto"'" CLAIM FOR HOMESTEAD PROPERTY TAX
�, ._,. � STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R72 / 6-09)
�O f P�esrsibed by lhe DepaNnent of Loral Gwemment Frmius
INSTRUCTIONS: See iaversa side for filing instructions.
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�iWe)�, '� ' !l(iZ0 ce��%fiu�e�iii�bi�dAa�mYlo�)Prindpal
place of residence a(are) buying the following described real property for which a Homestead Property Tax Standard Deductlon is hereby daimed
under contraq on Ihe date this appliration is filed, (date o/filing): '
❑ I(We) own ❑ Am (are) buying under recorded contract
❑ Am (are) enfilled to occupy as a tenant-stockholder ot a cooperative housing corporafion �
� Have a beneficial interest in Ihe Wst or [he righ� to occupy Ihe property under ihe terms of a qualified personal residence Wst
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Recard numbei Page
t (rity, town, foylnchiP)
Parcel number Legal dew-ip]6,�m�. � � �/�.�,,,�� Is Ihe properry in question:
� / r(,C,pflywr S � Real property ❑ Mnua�y assessetl mo6ile home (IC 6-1.1-�
It any ponion U Ne resdentlal swcW re w Ihe IaM'rot excee0"ug rne (1) aae that immetliately surtwnOS Nat strucNra is used m protluce imm�e, Ceuribe �he use aM poroon
of Ne pmperry unT¢eC to pmtlure inmme.
a�-a.a-4� -soa -ooa.yas-v a.y
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I hereby certify the above sfatemenis are we, correU and complete.
La�d
acre immediauty
Otherland
Total land (line f plus line �
Dwelling
Garage
Other imOrovemenb
Total improvements (llne d througA line �
Total value (line7 phs 1(ne �
I hereby certiy the above is true, cortect,
and complete.
Vaifyi� admn - Signature ot /wtlitw
(�)
(Z)
(3)
(4)
(5)
(6)
(B)
IN
20 _ pay 20 _ Lesser of 60% of the assessed value ot the homestead or $45.000
Nolwithsfandtrg anY �erprovisim, fhe sum W the dedut(iars pmNded /n IC 6f.1-12 to a rtmbl7e Inme Nat ic 5
rwt assessed as real property w to a menufactured frortie Nat is rat assessed as real propeM mey rwt erceed
one-lietl(12) W the assessed valua o/ Ne mo6ile homa wmanNartu�etl home.
ignaWre otividitor � _
TavnsNp
(mrnfi. EaY. Yea�
Date signed (rtronN,
Date signetl (mmN, day, yea�