HomeMy WebLinkAboutHomestead_Luke""" CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
_ STANDARD / SUPPLEMENTAL DEDUCTION H o
S State Form 5473 (R72 / 609) .
�O , � Prasrribed by ihe DepaRmerit of Loml Govemme�ri Friance �
�
INS7RUCTiONS:Seerevarseside7wfilinginsmic(ions � I %-l�'���'_ 2011
. .
�� (�`�e) certify that I(we) i my (our) prindpal
place of residence or am (are) buying the following described real property for which a Homestead Prope��r�d���ytl' ' hOerReby daimed
under mnVact on Ihe da[e �his a liption is filed, A
PP (date o/filing):
�(We) own ❑ Am (are)�buying under recorded conVaa
�❑ Am (are) entiUed to occupy as a tenant-stockholder of a cooperaUve housing corporation
� Have a beneficial interesi in the Wst or the right to occupy the properry under the terms af a qualified pereonal residence Wst
•• • •
Name of da" (kga/ neme) .
Sotial Searity
�
SoUal Securiry
\SE/�
� ••� �
If buying on Fre Simple ownefs riama (`,
)`1 \ \ diC� i L' � `'
RecorOers ofice where mnlraa is remrdeC Remd number Page
._�. . � , �
Counry Township Te�mg d'a (rily, wn Iownship)
� Parcal number Legal descriP� Is e perry in Qurslion:
,Q Real Woperty ❑ MnuaOy assessetl rtpb0e home (IC G7.7-n
If any portbn of Ihe resiEenilal sLUCWte w �ha Ia�M nol axceedug ma (7 ) ace Ihat immediately surtou s that sbucNra is useA to
of ihe P�PenY ���� � p�uca incrnne. W�duce Incame, tles�ibe the use and portion �
a�- /�-o�' �ov _�o3.9r�-oa �
..- . , : . .
Counry ' Township Counry Towrtthip
I hereby certify the above statements are We, cortect and oomplete. Sgnature ot daimant -
MEress(numberard reet,tittt;ste arMLPOOde)
DdoW.� ��-� c���eE-lo�,�a y�l��tl�
.- .
. . .. . ,
�, . . '
Land not exceeding 1(one) acre immediately ��T=j�a=�:'-0.'��^�T�i�s �- `T
3�.rY.2 naa. ���' 'i'�
surtoundin resitlentialim rovements. ��) ;.,�s„',.-'.,,��^.,��,.4__a..�;t;�'.�.g'_'�.;'.;;
Other land (2) �}y Y�'`3,��+T�����
7atal land (line 1 plus line 1) (3)
Dweliing (4) � z ��'+��`������"*'-t�
ResldenUal Improvemenb or Mnually ��.�t^�t �.p r�st zc'�'rq,;;a ss�%
AuessetlMObile/ManufacturedHOme Garege 5 �.�i-AS`H-;.'��.,�,'_'�'��`f�t�`'''
� � � C�'-I��r,c...:YVi."�'.l`.'.'��.r�`.�,'.').i�
" v r.�?ae'r ^'y!'.
Olher Impmvertrertts (6) .�%{if;�„.,n��_z
Tofal impmvements (Ilne d Nrough Ilne � (7)
ToGI value (line 3 plis Nne � (8)
�I hereby certify the above is hue, cortect. Sg"aNre at Asseu°� Date sig^ed (m°^u'� daY yee�
and wmplete. �
VeJyiig acCOn - Sigreane of �tor Date signed (manN. daY• Y��)
�..� � � • •
20 _ pay 20 _ Lesser of 60% of the assessed value of 1he homestead or $45,000
. Nofwi(AslaM6g any dherprovivan. Ne sum W Lre tlMucbons proNded in IC &7.1-71 fo a noblM hort�e Naf is $
' mt assassad as reelWWertY w to a mawtacturad Iwne fhat B nol assessed es real pmpeily maY �rot eaceetl _ .. .. ' _
� wq�haH (f2) d fhe assessed value d Ne mobda Mme ar manWarlure0 home.
S9naWre otNW'nnr Dete sigrred (monN. tlaY Y��