HomeMy WebLinkAboutHomestead_Pfeil"'" CLAIM FOR HOMESTEAD PROPERTY TAX oa'
� ._ � STANDARD / SUPPIEMENTAL DEDUCTION n ,�I �
State Fortn 5473 (R12 / 6-09) � \ ,
�O � Presmibed by the Department of Loml Gavemmertl Frence
INSTRUCTIONS: See reverse side fof fi(ug insh�Uions.
FORM Y�
HC10
� �
�(We) 7/ Y/ / certify that I(� ocwpied as my �oYir) prindpal
place of residence or am (are) buying the follo 'ng desuibed real property for ch a Homestead Property Tax Sian�r�leduction is hereby daimed
untler mniract on the date Ihis applipfion is filed, � (date of filing): G.IBS ��
❑ I(VJe) own ❑ Am (are) buying under recorded contraG �� C�UN �
❑ Am (are) entilled to occupy as a tenant-stockholder of a cooperetive housing corporation T Y AUDITOR
� Have a benefidal interest in the Wst or the right to occupy the property under the terms of a qualified personal residence Wst
Name ol
11 buying om m�tract, Fee Simple awneYS reme
I
Remrdefs of6ce where mnlraG is mmrtleE
Couny ramship
Parcel number
of daimant (Wsl
Drimrers Gcense / Identifration /
Eitbia (rity, toxn. townthiP)
Is ihe 7�oPerlYin Wrsiion:
Issuing
Remtl number I Page
- U Real propeny U MnuaOy asusud moM'le home (IC G7. f-n
�II arry portion of Me �sidential swcWte or ihe W� not axreed4g orre (1) aae Nai immediatety sunwnds Nat sWCNra Is usetl b pmauce i�me, tlesmiGe the use and ponion
a me p�operry w'� m pmauce inmme.
p2lo-6�-�-,3�o-oT40-DO%0�9-ao?�% �,00a s�lV
�
f1' 1'
u
T�„
I hereby certify the above stetements are we, mrrect and complete.
antlLPooOe)
Land not exceeding 1(one) acre immediatey
aurtounding residential improvemenLS.
Olherlantl
Total land (line 1 plus line �
ResidenUallmprovemenborMnually �����9
Auessed Mobik / ManufacWred Home Garage
Other improvemertt4
Tofal improvemenb (Ilne I Nrough line 6]
Total value (!!ne 3 p/�s Ilne �
I hereby certify ihe above is true, wrtect,
and complete.
Vaiyi�g action - 55�yra of �tor
(�)
(Z)
(3)
(<)
(5)
(6)
of Assesmr
Caunry
ot
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
NWwiMSfaMirg eny otherprovision, Ne sum olNe Oetluctions provided in IC G7./-7Y ro e mob0e Ipme Naf Is $
not essazsed as real property a Io e manufartured hwne fhat's nof assessed es reel poperry may rrot erceed
one�haM (iR) d tlre assasse0 value o1 Ne mobda hortre wmanWaUU�ed home.
$ignaWre of Audiint
rowrtmp
Date signeC
Date signcd (rtronth. daY. iea�)
Date siqned (monlh, EaY. Y��
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