HomeMy WebLinkAboutHomestead_HeavrinCLAIM FOR HOMESTEAD PROPERTY TAX
_rt• '� STANDARD / SUPPLEMENTAL DEDUCTION
S� S�ata Fortn 5473 (R72 / 609)
�O � Preunbed by Ne Departmerd of Local GovemmefR Frmnce
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I��:i-� !1 1 _�
lNSTRUCTIONS: See raverse side Ior filing inshuuions. � `-yr/c ���y�
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I(we) (� certiry tAat 1(we) ocwpied as my (our) prindpal
place of residence or am (are) buying the following described real property for which a Homestead Pmperty Tax Standard Deduclion is hereby daimed
under contraa on the date Uis applintion is filed, (dafe oIfiling):
❑ I(We) awn ❑ Am (are) buying under recorded conVad
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperetive housing corporation
� Have a beneficial interest in the Wst or Ihe right to occupy the property under the terms of a qualified personal residence Wst
.• • •
Name da'vnant (leyal neme) �
Sotlal Seauity rurtrter d (lasf fr.e dig3s) Drivels Ikeroe / Identifi�stion / Olhu �um�r � Iswirg State
«���<<,�u�,�d��,
N e da6nanYs spaae (legal name)
�J",�-�-�a-� %d�-� �
Sodal Seamry number of daimanPs spouu (last five dlgits) DrivNS ticense / Identifxation / Other
�
. .•� �
If buying m mntract, Fee Simple ownels name �
RemrEeYS o(6ce vTere contrzG is rewrEeG � . Record numher Page
..�• • � • •
Caunry Tvwns�ip Ta�dnB d� � (�+A'�P)
Pa�eJ numher I tlesaiDtion 3�.'� —' Q Is Ne P�PenY in Westirn: '
�NE S,E 3. d_ [�Reaiwocenr ❑/���`/assessedrtrobilehome(ICGf.f-n
It any ponian of tne resldentw swcwra «�he larid not exceed"ug ma (t ) aue uiat ImmetliateN swrwrMs �hat smrcw`e is-usee tu poauce inodne. desrnbe the use and portion
� a me wovem unazaa m a�a� ��. , .
a(o-��--0 3 you�- 000. 387-oa7
�.- . .: . .
� Cwmy Tvxns�ip . Counry Tovrtahip
I hereby certify ihe above ststements are We, corteU and complete. Signature a1 daimam �
`� neeress(ru,mceraneweet,cit�:uete.amLalndej� ^
%. 3 3 a � i o .v �Y76 � o
.- .
. . ., . �
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LanA not exceeding t(one) acre Immedlatety `�`� "s i...'.���"�:?+� "�;�
surtoundi resltlential im rovemen�. �» .�3-�, ��� �3-`":i y,��c �:,E,r,
� F�Z�v. +F ti
Otherland (Z� ..,-���'r� ,
7atal land (fine 1 plus line � (3) '
or+emn9 (a) x`''�-�'".���''�'2�'?'�'`;���-.�-'�--.'—£,�;5'
Resldentlal lmprovements orMnually �f•n•-*•�� �'gT�s•-=�'!:!='X�
0.ssessetl Mobik / Manu(actured Homa 9 5 �`��y`�':� 'w`} ;�-� tf,
Gare e ( ) �z�'�" 1S.a _.r�w�w`3'S°.'i-'r�
�
Other Improvemerrts (6) '�����'��"=�$
.y9�!. sj_:irr!u+^:�.
Todl Improvemenb (llne e through line � (7)
Tofal value (line 3 pl�a line � (8)
I hereby certify lhe above is we, cortect, Sg"afl'� °f �� �� `'�^� (R1Of1U'� ��%�
and complete.
vetrymg ac�on - sy�rawr� mn,�mmr Date signed (marN, Eay, year)
� �.-.. . • .
20 _ pay 20 Lesser of 6096 ot the assessed value of the homestead or 545,000
NoNnNslarMng any afher provision, Ne sum of the deduc�ia�.s pro�ided in IC G7.1-1Y to a mob,7e Ipme Nat /s $ �
not assessed as reel property w fo e manufarlured hortie Nat is not asse.rsed as reel properry may rwt exoeed
onaheN(12f d Ne assessed value o/Ihe mobde home or manulaUUmd hm�e.
S19 ture o(AUdltw n y Date signe0 (manlh. daY.YeeA
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