HomeMy WebLinkAboutHomestead_Burress"'" CLAIM FOR HOMESTEAD PROPERTY TAX
� STANDARD / SUPPLEMENTAL DEDUCTION
1 ^ State Porm 5473 (R72 / 6U9)
�'` � Presuibed by Ihe DaparUnent ol Local Govemment Firiance
INSTRUCTIONS: See reverse side !or filirg instruclions.
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place of residence or a(are) buying the tollowing described real property tor which a Homestead Property ax S nda uUion is ere y daimed
under conVaU on �he date �his application is filed, (date of filing):
❑ I(We) own ❑ Am (are) buying under recorded contract
❑ Am (are) enliUed to occupy as a tenan4stockholder of a cooperetive housing corporation
� Have a benefictial interest in ihe Wst or [he right to occupy Ihe property under the lerms of a quali(ed personal residence Wst
name)
Secunry nurMfr
,
State � I
�.J
Issuing
Retmd num0er � Page
�nry T hiP Tabrg disiria (riry, tqfvy(township/�
7
ParcrJ numher Le9al rsrnPN� ♦ � o11�4C/ Is Ne wopenY in puestion: AmuaOy assessed modle home (IC Gf.7-7)
�v�:% Realpmperty ❑
If any po�tiai oi Ne residential sWGUra or the land no� exceed'ug orre (1) aue Ihat immetliatety surmun Ihat strucNre is used to produce income, dewibe the use anE portion
of �he property unTaed to produce i�me.
�lo-/a -08 -�03 -ooa. oy� -o�z�
Caunry
Tovmship
I hereby certify the above statements are we, correct and complete.
i
Addre�55�numDer antl street, tll}; slafe, and ZIP�e) n �
Land not e:ceeding 1(one) acre immediately
ONer land
ToGi land (line 1 pfus line 2)
ResidentlallmprovementsorAnnualty �Iling
Fssessed Mohile I Manufactured Home Garege
Other improvemenb
Tofal improvements (llne 4 Nrough ltne 6j
ToUI value (line7 Plu 1(ne �
I hereby certify the above is true, correct,
and complete.
Vailyutg et4on - Sigr�aLne oflwtlitor
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(3)
I4)
(5)
(6)
a)
�8)
SignaWre ofASSessor
Caunry
/
20 pay 20 Lesser of 60% o( the assessed value of the homestead or $45,000
Nofu�fASfarding eny otherpiovision, Ne sum o( the tletlucUOns provided in IC 61./-12 ta a mobtie lame Nat is S
mi assessetl as ieal property w to a manufaUUred home Nat is nat essessed as real properry may rrot esceed
ona-AeH/72� o/Ne assessed vdlue o7 fhe de Fwme w manulacturetl home.
iqpatureolNWltw /) �
Township
Date signed (mrnth, tlay, yea�
6ate s'xJnc-0 (rtronlh, tlaY. Year)
(monfh, EaY. Y��