HomeMy WebLinkAboutHomestead_Vanoven�'"'" CLAIM FOR HOMESTEAD PROPERTY TAX
�. _.. .. STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R72 /6-09)
�O •° Prescdbed by lha Departmenl of Laal Govemmenl F�nce
INSTRUCTIONS: See reverse side for!ling instructions.
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FORM YEAR
DfcEia 2 1 009
r�_�
I(VJe) �{ . V certi(y that I(we) ocaipied as my (our) prindpal
place of residence or am (are) buying the follow" described real property for which a Homestead Pmperty 7ax Standard Deduction is hereby daimed
untler mnVacl on the date ihis appliration is file , (dafe o/ filing):
❑ I(We) own ❑ Am (are) buying under recorded contract
❑ Am (are) entltled [o occupy as a tenant-stockholder of a cooperalive housing corporation
� Have a beneficial in[erest in Ihe Wst or [he right to occupy Ihe pmperty under ihe terms of a qualified personal residence Vusl
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(�au me d'g3sl
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If Guyuig om m�tract, Fee Simple ownefs name
Reco�defs ofice where conVad is remrCed
Caunry
Parcel numher
of daimant (las( frve digiGS)
Drivels Gcer�se / ltlentifiration / ONer number
of daimanPs spouse (las( frve d'
Tabng
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RecwC numher � Page
Is Ne mperty in queslion:
3�' !�/ l��Real propeny ❑ MnuaOy essessed mobiie home (IC S7. f-
arry portion of Ne resiCential sVUCwre or Ne IaM not exceed4g wre (1) aae lhat immeCia[eJy wrrounds �hat smicWre is useA m protluce i�ort�e, Eestnbe Ne usa anC portion
tlie PmPartY uo�¢ed Io W�ure income.
a(o-o 5 - 3�-,z.00_oo�. /83 -od 7
Counry
Township
I hereby certify the above statements are We, correcl and wmplete.
/Address(numDeranOStreet,dry, te, OLPCOtle)
Z37 � U/c� e t_ s6�•
.- .
Land not exceeding 1(ona) acre immi � —
surtounding residential improvemenC
Otherlantl
Total land (line 1 plus line �
Residentlal Improvementa or Mnuall7
Assessed Mobile / ManWactured Hom�
Other improvements
Total Improvementa (llne 4 Niough I(i
iatal value (line J p(fs line 7)
I hereby certify the above is true, c�
and camplete.
Vailyirg aaion - Sigriawre ot Pudtw
Caunry
of dalmant
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20 _ pay 20 _ Less�
Nohvrthsferadin9enYOfherprovisia�, Ihe
rot essessed as real poperty w!n a menularlured hwne Nef is rof assessed as real pmperry mey rwr esceed
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