Homestead_Sellers�""' CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTALDEDUCTION
1, State Fortn 5473 (R72 / 6-09)
�O � Prnun6ed by Ihe Department of Lacal Gmemment France
INSTRUCTIONS: See reverSe side for fJina insVUCtions
FORM YEAR
I(4Ve) certity ihai I(we) occu`'g�as my jpu�,prindpal
lace ot residence or '� ��a"` " �"
p (are) buying the Ilowing de b eal property tor which a Homestead Property 7ax Standard Dedudior� (�er«��.aimed
under conVact on Ne te �his application is filed, (date ol filing): ����g1'! CO_4�1T( py9�T9Q
�I(We) own ❑ Am (are) buying under recorded conVact
Am (are) en6Ued to occupy as a tenanbstockholder of a cooperative housing wrporation
� Have a bene(dai interest in �he Wst or the nght to occupy the pmperty under Ihe tertns ot a qualified personal residence Wst
•• • •
• ••� �
If bu}'v�g om m�trad, Fce Simple ownrls `ume
Remrtle�s oftice where oonbaU is recorded Remy number Page
..�. _ � . �
Coun Tovmship Ta�dng E' '('.town, mwnshiP)
(
Parcel num6er L I des 'ption Is Ne mpertyin quesiion:
' Real property ❑ MnuaDy asusud mobile home (IC G7.1-n
If any portim of Ne residential swcwre w Ne IafW not exceedi (1) arre that imm@p►tel( ds �hat swmre a used tn produce income, deuriba the use and ponian
af Ne pmperty uu7¢ed to ProOUCe income. � CT
�_ �3_ ��_ �aa- �Qa.a 9a -o�SL
-.. . , : . .
Counry Township Caunry Townsttip
I hereby certify the above statements are We, correct and complete. Signaw a1 daiman � �
O
ACdress (numbe�and stleet, crty; sfate, and LPCade)
O�E3o S o K ��57' y4�,1 .4 T�Z��
�_ , � . •� . �
�� .. �
land not exceedirg t(one) acre tmmediatey � I� h;�y ,� "�.�'"-��,�'{�`a� v:��
surtountlin res(tlential im rovements. �� — U._ r�.u,e
Olher land (2) ���"� � �+- '
e :�°`c`.'6'' -c??s, %R
Total land (line 1 plus line 2) (3)
Dwellin � .'`v i...�,�3{/:�-`�`'.�.,�,� ijr��y�
ResidentlalimprovementsorMnualty 9 �4) � � �a�Z��dqY�"a". "� _ `-t�,�
ASSessed Mohik / ManufacWreE Hame 9 � a.-i �s�.±,�^ y? y.�sry.�
Gara e (5) �.-£._..Y.'. '.ri��s`-�ti�,1it��.xSF�.°:'�^'c':
Other imOrovements (6) '�.�=`5 `'�5;�`,'��i.
>a _tc::,.=gl�fi,�=.
Tofal improvements (llne 4 through Iine 6j (7)
Total value (Ilne J plls 1lne � (B)
1 hereby certiy lhe above is true, correct, Siqriawre of Assessor Date signed (manth, aay, yea�
and complete.
Vailying aaion - Sigfay�e o(Ndieor Date signed (mon(h, Cay, yea�
�.-� • � • •
20 pay 20 Lesser of 60% of the assessed value of the homeslead or $45,000 �
NWµtlNSlantling any olhe�proNsion, fhe sum o1 the deduct-ons pmviCed in IC G7.1-1 P ro a mob�e home ihal is $
rof assessed as real property a lo a menufeCUred home Nat ic mt essessed as rael pmparry may rot erceed
one�haH(12) d Ne assessed re/ue ot Ne mobie home or manufartured home.
SignaWre oi Audlmr Date signeC (monlh, Cay, year)