HomeMy WebLinkAboutHomestead_Reinoehle^""'^ CLAIM FOR HOMESTEAD PROPERTY TAX
i � ? STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R72 / 6-09)
�O �� Presaibetl by the DepaRmenl of Local Govemment Fnarce
INSTRUCTIONS: See reversa side /w fi(ing inshucfions.
��� � �
, FORM YEAR
tl,��g 2��
�l6 N
e�noeti� �.._..
�(�'�'e) � y� /� `L n �'�'� Il�i' �/i� /1 ��ll� ��,/� certify that I(we) ocwpied as my (our) prindpal
piace of residence or am (are) buying the following desaibed real property for which a Homestead Property Tax Standard Dedudion is hereby daimed
under contrad on the date this appliplion is filed, (date o/ filirrg):
❑ �(We) am ❑ Am (are) buying under recorded mntract
❑ Am (are) entltled lo occupy as a tenant-stockholder o! a cooperative housing wrporetion
� Have a beneficial in[erest in the Wst or the right to occupy the property under the tertns of a qualified personal residence Wst
Name of da' (leg I e)
Sodal Seamy
Name of dai a s spo a me)
Sorial 5 '
If buying om m�traq, Fee Simple ovmeYS �ame
RemNefs of6ce where mnvad is recoNed
CaunH � _ 7amship
numher
Counry
Orivers fi�nse / Ideniifint
of da'unant (Wsf frve tligfls)
Issui� State T�
�
Dmels Gcense / Identifuatla� / ONer
of daunanCs spouse (le5( frtre d'giLS) �-/ ��
(
Reco�d num6er � Page
ro�,
� ���� ��
�� �7 L/e�gal7 desaiP� Is Ne pmPertyin puesfim:
-(��p(. 7) -t%� ❑ Real Oroperiy � MnuaDy a55e55ed mobile home (IC 61. t-:
swcture or Ne Ia�M not exceeding one (1 j acra Nai immediately surtountls ihat strucWre is usetl m proAUce income, desmbe the use an0 poittion
ice inrnma. �
Twmship
I hereby cerlify the above ststemenis are we, cortecl and complete.
Address (iwmDer antl sveet, ciry, stete, end LP
Land not ezceeding 1(one) acre immetliatety
Otherland
Total land (line 1 plus line �
ReslAentlallmprovemenlsorAnnualty �elling
Assessed Mobile I Manufacwretl Home Garage
Olher improvemenfs
Total Improvem¢nis (line d Nrough Ilne �
Total value (line 3 pAa line n
I hereby certify the above is [rue, cortect,
and complete.
Vaitying aclion - SignaW re oflu�tlibr
(�)
(2)
(3)
(4)
(5)
(6)
(�)
(8)
Sigiuture otASSessor
Counry
of
20 pay 2p Lesser of 60% of the assessed value of 1he homestead or 545.000
NWwifhstaMirg eny olherP�ri�. Na wm d fhe dedutliau provide0/n IC 61.1-12 w a rtmb,7e home Ihat ic
mt assessed as reel property w to a rtunulaUUred hortre fhet # rot assessed as iea/ properry maY �1 exreetl
ana-hall,(7121 d Me assessed i8iee o1 th� mobde home or rrenu/actured hwna.
S
Township
Oate signed (rtronth, day, yea�
Date