HomeMy WebLinkAboutHomestead_Perry"'" CLAIM FOR HOMESTEAD PROPERTY TAX
� ._ ? STANDARD / SUPPLEMENTAL DEDUCTION
i State Fortn 5973 (R7216-09)
�O � Prewihed by Ihe DepaM1ment W Loral Goverm�enl F�ance
INSTRUCTIONS: See raverse side !or filing inshuctions.
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MAY 2 2012
I(we) / - certiry that I(we)`eic6p�d as my (our) prindpal
� place of residence or am (are) buying the following destribed re pe ich a Homestead F� `��£Gi6Ffd3M q�¢Ijtq�Rs hereby daimed
under conVaU on ihe date this appliralion is filed, (date of filing):
❑ I(We) ovm ❑ Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation
� Have a beneficial interest in lhe Wst or the right lo occupy the property under the tertns of a qualified personal residence Wst
�• • •
Name of pt ( al name) � I .I � n _
frve d'gks)
spouse
Iof daimanPS spouse (last five d'yrls)
11 buying on contract, Fee SimPle ownefs nama
Recortlef5 office where mntract ¢ remrdeE
Township
L al desaiption
Tamg
� ol �d `�S- � DD -CO .� l�G d d
tl any poffim of Ne residential sWCWre or Ne land not exceeding one (1 � arle ihat immediatety
ot Ne property unTaetl fo protlu�x inmme.
�
..�. • • � -
Courrty Township Caunl
i hereby certify the above ststements are true, corteU and complete. S'�`�
dress um6e�andsfrGet,y'rty,� e,qnl�IPrptlei �^��/ �
� h SL L%% CA
LanA not exceeding 1(one) acre immediatety
surtounding res(dential improvemen�.
Otherland
Total land (line 1 plus line �
Residential improvemenfs or Mnualiy �����9
Assessetl Mobile I ManuFactured Home Garage
Other improvemerrts
Total improvements (line I thmugA line �
Total value (line 3 pl�a line 7)
I hereby certify ihe above is true, cortect,
and complete.
Vaifying actlon - SignaNie of Audtw
��)
�2)
(3)
(4)
(5)
(6)
�8)
SignaNra of Assessor
� I20 _ pay 20 Lesser of 60% of the assessed vAue of the homestead or $45,000
Nofvnthsta�dirg any olherpm�.ision, Ne sum ol the detluctions provided in IC 6-f. f-f 2 to a rtp6de home ihat is
rrot axsested as real properry w lo a manWaUUied hwne Ihat 'a riot essessed as real piopeny mey not excve0
IsSUV�g
Record number �� Page
ry in qurstion:
property ❑ MnuaDy a3seSSetl mobile Fqme (IC 6-f. t-7)
�um2 is use0 to pmauce incorne. Eescnbe the use and portion
$
Township
Date signetl (monN, tlay, }sa�
Date signed (rtronN, day, yxa�
Date
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