HomeMy WebLinkAboutHomestead_McDonald (3)"'". �LAIM FOR HOMESTEAD PROPERTY TAX
�4.__ STANDARD/SUPPLEMENTALDEDUCTION
State Fortn 5473 (R72 / fi49)
�O 2 Prewibed by Ihe DepaNnent ol Loral Gwammem Fnance
INSTRUCTIONS: See ievarse side (orTding instruttions.
}� T YEAR
�7 F�RM �
� �
JAN 5 2010
I(we) �� Q{�,� �E" �.�'J D Y17)7 c�. � c 1%_-"__`'"J ceSibJON @Y l4f�f'R' �b
place of residence or am (are) buying 1he tollowing described real property tor which a Homesiead Properry 7ax Standard Deduuion i
under conVact on Ihe date ihis appliralion is filetl, (date o/filing):
❑ I(We) own ❑ Am (are) buying under recorded conUact
❑ Am (are) enlitled to occupy as a tenanFStockholder of a cooperative housing wrporation
� Have a beneflcial inlerest in �he Wsl or the right to occupy the pmperty under the [erms of a quali(ed personal residence Wst
Name o(
('
OriveYSfrPnselldenvfrat
W tlaimant (last frve digitsJ
/
Umrefs lcense I leen�fication IONer number
ot dairtanYs spouse (las! (rve dgiGCJ
If buying on contract, Fee Simple ownefs name
Remidefs otfire where contraG is recnNe�
Caunry Township
prindpai
daimed
�� >� ..�...� � �
Issuing
�
RemrE number Page
lown, hio) .
Pa�cel num6er Legal description Is Ne propeny in Qu�tion: �—
� � Real property ❑ AnnuaAy ass¢gg W rtqWe home (IC b1. f.:
11 any poNOn of Ne revdanilal swcW re w Ne IaM no� exceedUg ane (1) acre lhat immediatety surtountls Ihat sUU�re is usetl m produce income, dest�iibe the use arW portion
of Ne pmperry utif¢eG W pro0uce income.
a�-/ a/s-ioo - voG. o�- oa%
Township
I hereby certify the above statements are we, correct and complete.
4tltlress (number and stieet, uty, sfafe, antl LPcotle)
Land not exceedi�g 7(one) acre immediatey
surtoundina residential imorovements.
Otherland
Tofal land (line 1 plus line 2)
ResidenUal improvements or M
Assessed Mobile I Manufactured
(�)
�
Dwelling (4)
Gaage (5)
Other improvemenis
Total improvemenb (/!ne / Nroug� line 6J
Total value (fine 7 p/'s /!ne 7)
I hereby certiy the above is true, correct,
and complete.
Vaifyirc� aaion - Sig�uyra ol Nidiw
�)
(8)
SlgriaNre of Assessor
f..� �
tlaimant
20 _ pay 20 Leuer of 60% ot the assessed value of the homestead or $45,000
NM.�ithstard'ug any otherryovision, Ne wm d Ne detlurliorts provitled in IC 67.7-12 to a rtw6�le fpme Ihaf is
rwt assessetl as real property w fo a rrenu/ectured hwne that k nof assessed es real pmperty may rof erceed
rne-hall(12) o1Ne assessetl rdlue W fhe rtabde home ormanufarturedfarrie.
E
Tmmship
Date signed
Date signed (rtronth. tlaY. Y'��
N�tlitw I Date