HomeMy WebLinkAboutHomestead_Douglas (7)s�'"'" CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD / SUPPLEMENTAL DEDUCTION
- State Portn 5473 (R72 / 6-09)
�,�' 2 Prescri6ed by the Department at Loral Gmemmem Fnance
INSTRUCTfONS: See reverse side for filing instrticGons.
—F .r M EAR
�4 MAY 5 z010
I(VJe) certitQl�PFtCJe}t1f.L{l�iEd a^s 1'n'y'(our) prindpai
place of residence or am (ar 'ng the following described real prop for which a Homestead Property Tax Standard Deduction is hereby daimed
under mnVaG on Ihe date �his appiipfion is filed, (date oI filing):
�i(4Ve) rnvn ❑ Am (are) buying under reCOrded cont2ct `
Am (are) entitled to occupy as a tenant-stockholder ot a cooperetive housing wrporalion
� Have a beneficial interest in the wst or the right to occupy the pmperty under ihe tertns ot a qualified personal residence Wst
Name of tlaimam.(legal name)
�-'•_•J
spouse
If buying on contracl, Fee Simple ownefs �ame
Recoidefs office where runVad
Counry
Parcel number
Trnvnship
ol tlaimar({W9 frve tlyiGS)
Dmers licanse / Identi:ration / ONer number
of tla'unanYs spouse (Wsf frve dgits)
If any portion ot Ne resi dure or ihe land not exceeding me (7 ) arne that Mmediately s
of Ne P�oPertY utif¢ed tn p inmme. � J
a�-�i-i3,,ao - ��`�. `fd�=oa7
.,. , , :
Counry I 7ownship Caunry
I hereby certify the above statements are We, cortect and complete.
Address (num6eraMSireet,
Land not exceeding 1(one) acre immediately
surtounding residential improvemenis.
Otherland
Total land (line 1 plus line 2)
Residential improvements orAnnually �e11ing
Assessed Mobile / Manu(actured Home Garage
Other improvements
Totai lmprovements (line d fhmugAline �
Total value (Ilne 3 pl`s line 7)
I hereby certify the above is true, correct,
and complete.
leifying acUOn - Synature oflwditw
n)
(3)
(4)
(5)
(6)
�)
(8)
otASSessar
I155uirg Sate
Reto�d number Page
foxn.tav shiy _ �
ihe property in Queslion:
!� Real Property ❑ AnnuaOy essessed mohile home (IC G1. f-n
s Ihat sWdura is uud m pmduce income, descnbe �he use and partian
20 _ pay 20 Lesser of 60% o( the assessed value of the homestead or $45,000
NofwiNSlaMiny anyWhe�pmvisbn. Ihe sum o71he dedutliau proviOetl in IC 6-1.1-12 to e moW7e home Naf is $
Tamship
Date signed (mwnh, day,
(monN. daY. l'ear)