HomeMy WebLinkAboutHomestead_Banister"'" �LAIM FOR HOMESTEAD PROPERTY TAX
i,-_._ s STANDARD / SUPPLEMENTAL DEDUCTION
Slate Fortn 5473 (R12 / 6-09)
�O ✓� Presc6bed by the Department of L.oral Govemment Friarice
INSTRUCTIONS: See reverse side for �ding instructions.
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� � M�e) , ceia�f�!'i���d°��iY iour) Prindpal
place of residence or am (are) buying the following describ eal property for which a Homestead Property Tax Standard Deduclion is hereby daimed
undei conVact on Uie date Ihis appliralion is filed, (date o/filing):
❑ I(We) own ❑ Am (are) buying under recorded conVact
❑ Am (are) entltled to oceupy as a tenant-stockholder of a cooperafive housing corpora6on
� Have a beneficial in[erest in ihe Wst or [he rigM [o occupy the property under the terms of a qualified personal residence Wst
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Nameofdaimant(legalnama) n �
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Sadal
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Sodal S
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If buying om m�Vaq Fee Simple owners riame
RemrGefs otfifi where mnVap is recordeC Remrd number Page
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��ry Trnmship Tarinp tl' tn (rJry, town, towRShip)
Pamcl number Lepal escriplion Is e pmperty in QuesGOn:
' Q�(� �� eal property ❑ Annuatly assessea mobile home pC bt.7-7)
t1 arry portion ot the resieentW suucwre or the WM no� exreeOing one (7 ) ace ihat imme0iatey su`rounds ihat swc¢�re is used to pfodure incame, eesrnbe ihe use aM portion
t Ne p�operty u0T¢ed N produce inmme.
�(o-l�-07-400- o�l. /�9-oa�
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CourrtY TawnshiP Caunry Toxnship
I hereby ceNy Ihe above sta[ements are We, correct and compiete. Signawre of daimant �
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Atldre�s1s (rvimDe�)r and streef, rn1y, sta;e, aM LPcotle) / 1
YS.S7.'��MO/IT !`�Ke T . `t_T% �
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Land not exceeding 1(one) acre immediatety y.^� } '�"�'` 1�`'�`'� +=
surtoundin residentialim rovements. ��� 'L.:'.�i'�nt-=�' ��.a:
Other land (2) �ei�r'�"�;�-'<,�"�u"<.s'n'..'y���.'.4"-,`
Total land (line 1 plus line 2) (3)
G` e t
Dwelling (4) iy:4"�'Ny C,��.+'�a m�-.�Y rU�
ResidenUal improvemenb or Mnualy
Assessed Mobile I Manu(aclured Homa '��' ���` 7"+x 9� '+=k�..•:
Garsge (5) � { ' �''' �e�.c�:'�"!`s3a'tE^.�,'stin� �:
Otherimprovements (6) "'� i�iyr�,v..�
Total improvements (line 1 thmugh 1lne 6j (7)
Total value (Ilne ] pl(s Iine 7) (B)
I hereby certify the above is true, cortecl, Sigiutura of Assessor Date signed (mrnth, day, yaa�
and complete.
Vai(yi�g aaon - Signature of /wditar Da1e signe0 (rtronN, tlay, yea�
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20 pay 20 Lesser o( 60% of the assessed value of the homestead or 545,000
NotvANSlaMing any otherpravision, Ihe sum ol fhe detluct6rtt proritled in IC G7.1-72 fo a rtroEde home Naf is 5
mt assessed as 2a1 property or (o a menu/acturad hortre ihet ic nof assessed es real pmperty mey rof erreed
one-heH (72) o! fAe assessed vdlue ot Ne mobile home w rranu7artured home.
Signawre ot Auditor 2 Date signed (month. day, yea�
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