Homestead_WilliamsonS,"'". � CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
Stata Form 5473 (R12 / 6-09)
°�w ° Presaibed by tha Departmenl of laal Govemment Fnance
FORM YEAR
HC10
INSTRUCTIONS: See reverse side /or filing instructions. O�
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I(We) / Sd� certify that I(we) occu ied as m�gy¢�/prindpal
place of residence or am (are) buying the fol owing desaibed real property for which a Homestead Property Tax Standard D�i(1�1�2c�hereby%da'
�un r mnVact on ihe date Ihis application is filed, (tlate o/filing): N CO N1Y pUD1�
I (We) own ❑ Am (are) buying under recorded contract GIBSO
❑ Am (are) entitled ro occupy as a tenanbstockholder of a cooperaUve housing corporation
� Have a beneficial interest in Ue Ws[ or the right [o occupy [he property under Ne tertns o( a qualified pereonal residence Wst
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tt buy'uig om m�tract, Fee Simple wmefs �ume
RecoNets of6re where mniraG is remNed Recard numEU Page
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Counry ��y � ' TownshiP ' T . . .d � , low�4 townsfiiP)
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Pa�cel nU L I EesaiO�n 19 Ne periy in qUeslion:
Reai WoPertY ❑ Annua�y assesseE rtabBe home (IC G7.7-7)
�It any po Ne residen�ial swcture a Ne Wnd not ezceedin e(7 ) a at immetliatey sunoun s Nat swcWra is used to protluce income, descnbe the use and partion
of the p�o uN¢eC to pmdufe inmme.
01�-,73- /G -/oa--oo�. �4��-oaS�
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Counry Township Caunry Township
I hereby certity the above statements are We, cortect and complete. Sgnawre ol daimant �
Address (iwm0er antl sfreel, dry, sta.e, antl LP cotla)
izzo S�oot HaubsJ��+ ir� 47�39
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land not ezceeding 1(one) acre immediatety $'�r 1 ���` 1 r',` -F`�;.�� �r rg
surroundin residentialim rovements. ��� 5�::� �.-��sr..:��''" -�-�,s�;�
( ) t�- � �i '^-;;
Other land 2 t,�._..�.s�+�a� :_z_
Total land (line 1 plus line � (3) .
Dwellin9 (4) �..:4�r7..v �4.�f�z'�s�ct'.�:
Residenllal improvements orMnualty �-t�'�'�^4 s� 'f *- �'^Y:="";
Pssessetl Mo6ile I Manufac[uretl Homa .' �* s,,y�pR?xjg ^" "+°?=-
Garege (5) �t �"- �i ���+s�'�s_'Ty`'%�::rrF.�E
v�:
Other improvements (6) � Z..�� rahf,�y,��
7otal improvemenb (line e Nrough llne � (7)
iotal value (line 7 pAs line 7) (B)
I hereby certify tha above is We, correct, �"a� °t�essOr Date signed (rtronM, day, year)
and complete. _
Vaifying actim - Signahrte oi Auditw Date signed (rtronN, Eay, yea�
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20 pay 20 Lesser of 60% of Ihe assessed value of the homestead or 545,000
NMOithsfanding eny olher provision, Ne sum o7lhe deductions pro�itled in IC 61.1-72 to a mo6tie home Ihat B g
m1 assessed as real propeM w to a menufartuied hortre Net is rot assessed as real pmperry mey rwf esmed
me-hatl (72) oI Ne assessetl relue of Me mobde �ome w manNactu2d homa.
SiBnature o/NMltor Oate sipneE (monN, day, yen�