HomeMy WebLinkAboutHomestead_Reeves (3)CLAIM FOR HOMESTEAD PROPERTY TAX
. __ STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5673 (R13 / 72-09)
���» � Resai6ed by Ihe Department af Lacal Gwemment Finatxa
/nlCMlll`TVIAIC� Cnn mvmm� rdn fnr Flinn inefn��iinne
FORM YEAR:
10
• •
��yye� . . � . � certiry tt�!�iyq as my (our) prindpal
place of residence or am (are) buying ihe following described real property fa which a Homestead Properry Tax Standan7��u '� is hereby daimed
�er mntract on ihe date ihis application is filed, (date o!filing). I(We): G�gSON COUNTY AUDITOR
Lf pwn � Am (are) buying under recorded contrsct
❑ Am (are) entitled to ocwpy as a tenant-stockholder of a cooperative housing mrporation
❑ Have a benefidal interest in Ne Wst or ihe right to occupy the pmperty undar ihe terms of a qualified personal residence Wst .
❑ Am (are) the shareholder, pariner or member of the entiry that owns the property.
�- . • s
Name o( nt (legal name)
' Seartity
Sodal Sewriry numbar W tlaunanYS spouse (WSf five d'gtls) Orim�ers lircrte / Itlentlficalion I ONer number Issuing State
of daManCS spoux (last five diprGS)
� �'� �
�{ y�ny on contract, Fee S e
Recortlefs of6ce whme rl is recorded RecorA w Pa
•e• • •
Counry Tw+vslu Tarin9 �� (aY town. fownshiP)
Paael number Legal tlasWption '�[e„� Is the proparty in 9ues[ion:
M%� ❑ Real P�P�Y ❑ MnuaM assessed mobUe home UG G7./-7)
It arry portion of the residential swcture w the not e:ceedin9 on (t) aae that immetliatey wrtaunds that struaure is used tn produce incame. Cesaihe Ne use aM pwtia�
d Na P�WanY utiOZSC N W��� inmme.
�lo-Id_DS- c�oo- �v�. P�Y-oa�
-.• . .: . .
Counry TwrtvshiP Counry Township
I hereby cerOry the above statements are We, correct and complete. Sigretu �daimant � �
.;/[
Atldress (numDer eM straef, dry, state, ard LP ooQe) •
/°-F �f '7 E C o n s e f R e �- I�c L v
. . .. . .
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� � �,k �.� .Yr, -,
Land not exceedln t orre) acre Immediatey (� �° ��,ey.� ..3;:
surtoundin realdentlnl im rovemants. � -�•�'a�-� �'-'�-� - ='���
Other land (2) �iF� �4'�:��+�-��
Total land (lirte 1 pl�s lirre 2) (3)
a
Residerrtial improvemen� or Mnualiy ����ng (4) ���� �^--g� � �, `_-'- ��-n sa �.+�^
0.ssesaed Mobtle / Manufanh�red Home Ga�9e �5� �.��` SJa t.a.�. k�� f',�F'`�
Other ImprovemeMS (6)
.r '� ���i��f,%f:
Total improvamerhs (Ilne 1 fhrough line 6j (7)
Tomi vawe �rne a phs mre � (a)
I hereby certify the above is We, cortect, �9^a�re o(�sessor Da�e si9� (��• �Y N�
and eomplete.
Verifying aclion - Signature oflwditor Da� signetl (month. day, yee�
�.•� � • • �
20 _ pay 20 _ Lesser of 60% M the assessad value oi the homestead or $45,000
Nolwi(hsfanding anyWheipiovisian, fhe sum ot the Ceductims ryowdeC in IC G7.7-f 2 ro e nwW7e tame fhat is $
not essessed es rael property w to e manWactured fwme Nat is not assassed es real property mey rrof exceatl
one-haC (72) ol Me essessed velueW the mo6de lrome wman�dactured lartre.
Sq�naene af gydi�or Date signed (month, daY. lsaA
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