Homestead_Brown (9)c
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" CLAIM FOR HOMESTEAD PROPERTY TAX
i, -_,. STANDARD / SUPPLEMENTAL DEDUCTION �
State Fartn 5473 (R72 / 6-09) .
�O � Prewibed by Ua Departmeril ol Local Govemment Frer�ce
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INSTRUCTIONS: See raverse side lorhling instniUions. � c� 3_ ZUi�
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, � M�e) • cer�ii�y ,�I:Nv2T��occ'�i�(ed as my (our) prindpal
place of residence or am ( real property for which a Homesiead Property�St atnld�ad.D�dllaloM�here6y daimed
under mnirad on the tlate Ihis applicatlon is file4 (dafe o/filin G��SO�� ��1�TM
9)
❑ I(We) own ❑ Am (are) buying under recorded contract .
❑ Am (are) entitled ro occupy as a tenant-srockholder ot a cooperative housing wrporation .
� Have a beneficiai interest in the Wst or the right to occupy the property under the terms of a qualified personal residence trust
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Name aunam ( 1 na e
Sodal Smnity
. .-, ,
If buying m contrad, Fea Simple ownefs riame �
RetOidefs offite where mntraG is retrnded - ReOOId number Page
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Counly Township " Taz'vg QaLitt (ull: town. towrtshr0)
r- rLMer (� Legal drscnD� Is Ihe property c� question:
I p� ��v � p/O I� 3. � �' � Real yoperty � AnnuaDy assessed mod'le home (IC G7.1-�
Ii any poNion W the fesldential sWmra n the IaM not etteeOing ana (7 ) aae ihaQ1�� surtountls Nat strucNre is usetl W Produce i�ame. dascnba Ne use aM portion
� of Me PmPenY wT¢ed to poduce uimme. /� �
1/� a_ �
�y (.ires�
-.• . .: . .
Counry Tvwnship' Caunry Twnvship
I hereby ceNfy the above statements are We, cortect and complete. °�""a"� �
Pddress(num iandsheet,dry,slete, L e)
4?6
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Land not exceeding 1(one) acre Immediatety �? ,� ���� 1�a
surroundin residential im rovements. �� �' ,� �"� 3,_3?�"" -a3.�p�� s
Other land (2) �,�+.�§�'������` !
7otal land (lina 1 plus line 1) (3)
: v��` �ia�'' *by �t"c4 y''"�v,,�a3,��Y?
ResidenUal improvemenb or Mnualty
Dwalling (4) �, a��:'�f>..a��'i�.-�'��'s'a._:�r,.
Assessed Mobik I Manufactured Home Gars e . '���'"``�r" „p ��"�' ,�s� �� ��.4��"
9 (5) . €�f�t3' � .��'���.'��"+�3
r' '<`' :5�:�
Other impmveme�rt.s (6) � ��
s� �`�'`.:i �?;tk;
Tofal improvemantv (Ilne 1 Nlough Ilne 6) (7)
roai vawe �nne � Pns ene n (s) •
� I hereby certify the above is true, wrtect, Sgriature oinsussw .. oare signm (monm, tlay, year�
and tomplet¢.
veny��y acna� - sg�am�e a a�a� Date signetl (monN, day, yea�
• ..-.. . . .
20 _ pay 20 _ Lesser ot 60% ot the assessed value of the homestead or $45,000 - -
Abn�+tM14andirg anYWhe�Grovision. Ne vanW fhe deducfibru proridetl in IC 6f.1-f 2 to a mobr7e fpme Nat is $
nur e.ssessee es,eal vmpemW m 9 menweau/ee nmro rhe( k na essessee et,ea�wuvem may,ar exmm
oneheH(12J d Na essessad vafue W Na moE2e homB a manufactured hwne.
SigriaWre a(AUdltn Date signed (month, Eay, yea�
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