HomeMy WebLinkAboutHomestead_BostickS"' � CLAIM FOR HOMESTEAD PROPERTY TAX
i _ STANDARD/SUPPLEMENTAL DEDUCTION
State Form 5473 (R72 / 6-09)
�° 2 PrescriDed Ihe D
hy epartmenl af Local Govemment Fnaxe
reverse side for fifG�g instrucfions.
��
M YEAR
C7o
DEC 0 7 Zp09
�(We) �t )// Qi � i���� � cerlirythat���"t+ryiY (Qt�wPrindpal
place of residence or am (are) buying ihe following desaibed real property for which a Homestead Property 7ax Standard Deduction is h��y861laed
un er mnVact on Ihe date Ihis applira6on is fileQ (rlate olfiling):
I(We) own ❑ Am (are) buying under recorded mntract
Am (are) enli[led [o occupy as a tenant-stockholder o( a cooperetive housing corporation
� Have a beneficial interest in Ne trus� or the right to occupy the property under ihe terms o/ a qualified personal residence trust
Nama
F".^�11
Name of da'unanYs spause
Security numbrl of tlaimanYS spouse (lasf five
It buying on contract, Fee Simpla v.meYS rume
Remidels ofixx where mnVaq is recorde0
Counry TOwnship
ParreJ numher
��
�
umeYS YceRSe / laentifK'a�On / Other number
of daimant's spouse (lasl frve d'gits)
m of Ne residential siruccure or Ne IaM not exceed4g me (1) arre 11
erry u�T¢eE to qoduce inmme.
-/a-oG-�od - a oo. � �3-o�d
Trnmsmv
I hereby certify the above statements are We, correcl and complete.
(numDeranCStreet, ary, state, arW
Land not esceeding 1(one) acre immediauty
surtoundina residential imorovements.
Otlier lantl
ToUI land (line 1 plus line 2)
Residential ImO�a�ements or M
Auessed Mobile 1 Manufactured
Olher impmvements
(�)
(Z)
�
Dwellin9 (4)
Garage (5)
Total improvements (line 0 Nrough line �
iotal value (line 9 phs line �
I hereby certiy the above is true, cortect,
and complete.
Vailying action - Signatuie atividitw
(�)
(B)
Syna[ure o(ASSeswr
Counry
IIssum9 State
Recmdnumber Page
: fown, f iA)
✓
uoPertY in Westion:
Real property ❑ AnnuaOy assessed rtad'le home (1C 6t.7-7)
iat sWCWre is used tn pmduce Income, dewibe Ne use anC portion
.
� TowrvsFUp
Signature of daimani
fr
20 _ pay 20 _ Lesser of 60% of the assessed value of the homestead or $45.000
Notwif�slaMing any olherP�h��, �� athe Eetluclions P�o�� in IC &7.1-12 ro a mobde hame Net is
mt assessed as raal property or to a menufactured hwne fhat is rat assessed as real property meY not exceed
one-haHl7l1) o/ Ne assessetl vaWe at the mo0da fame ar manufartured hwne. '
5
Date slgned (monN, tlay, yea�
Date s9ned (rtronN, daY. Y��
Date signed (monN, tlay, yea�
5� �G �o