Homestead_Camden'°' CLAIM FOR HOMESTEAD PROPERTY TAX FORM Y�
. . STliNDARD / SUPPLEMENTAL DEDUCTION HCto
~ � State Fortn 5473 (R13 / 72-09)
t � Presrnbed by Ne Departrnent af Local Gwemment Finarce
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INS7RUCTIONS: See ieverse slde /or filing instrvcmons.
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I(We) . h/ � certiry that I(we) occupied as my (our) principal
place o( residence or am (are) buying the fdlowing described real properry for which a Homestead Property Taz Sfandard Deduclion is hereby daimed
�er contraC on the date Uis applintion is filed, (date o/filing). I(We): �
Own ❑ Am (are) buying untler recorded contract
Am (are) entitled to occupy as a tenant-siockholder of a cooperafive housing corporation
❑ Have a benefidal interest in the wst or the right to occupy the property under the tertns of a qualified personal reside�ce wst .
❑ Am (are) the sharehotder, partner or member o( ihe entity that owns the property.
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Name daimant (legal )
ti � Q �e
So�l
(lagal name)
Sodal Seamry numEer W da'unanCs spause (last fhre U'gfGS) Drivels fxema / Itlan6fiption I Other numbar IssWrg 9ate
of daimanYs spauu (Wstlrve tligifs)
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If buying on contrdU, Fee Simple awners name _
RearAer's otGCe where mntrea is recorded Record number Pape
._�. - � . �
�nry Township Ta ' I�}: ro .to� .
L
Parcel numher legal tlesaiplion Is 1he pmparty in Qu
� w�r ❑��M azs�see monue noma pc ��.,-n
It eny portion of ihe asidenUal structure or the IarM nol excceding me (1) aae Nat immediately su da ihat stru�hre is used lo pro0uce income, desmbe Ne use aId poNOn
of Iha P��nY utiliznd to pm0uce Income.
� a�- i a-05 yoo D66 d�a �a 7
:.. . . : . .
Counry Tovmship Counb Township
I hereby cerofy the above statements are We, correct and complete. Signs f nt
MEress (numDer antl stmef, cily, state, arM ZIP oode)
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Land nut ezceeding 1(orre) acre immedlatey (�� �'? ��y'4".,`��,y-��� �'� ��s�;
surtoundin resldential lm rovements.
re �:�
OtharlanA (2) ,"�,,,s�'r�,�,:=; ���
7ofa1 land (llrre 1 plus line 2) (3) �
ResideMlallmprovementsorMnually �IIIn9 (4) �„}�� `eA ."y,�y-�n.�
l�ssessed MobOe / Manu(acwred Home �"s ..,,�,`a'.�"�Er"�-�'-+-' - `� .�s;
Garege (5) .�-�� . �s:x.. ? i.fi a.�:r
otner�mprovements (e) :��`K�ssz�`���� ^
Total improveme� (Ilne 1 Mrough line � (7)
Total value (line 3 plus Ilna � (8)
I hereby certly the above is W e, correct, 59^a�re of Assessor Da1e si9ned (monlh. dsY. Y��)
and wmplete.
VeiN�9 aWon - SignaWre aflwdibr Da� signetl (rtanth. daY. Y��)
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20 �_ pay 2(1 � Lesser of 60% of the essessed value of the homestead or Si5,000
NofxiMSlariding any ofherpiovision, fhe sum W Ne deducfiorrs provitletl in IC 6f.1-12 ro e motik home that's $
not assessed as reel propeAy or to e menWauured home Net is not assesseC as real property may rwt exceetl
one-hall (f21 olMe auessed vahre of ttre moWie fama ormemdaGUred home.
Signame o1 Nditor ' Date signed (mon(h, daY. l��
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