HomeMy WebLinkAboutHomestead_Busch�'"'" CLAIM FOR HOMESTEAD PROPERTY TAX
_ � STANDARD / SUPPLEMENTAL DEDUCTION
S State Porm 5473 (R12 / 6-09)
�O 2 Presaibed 6y ihe Departmenl al Loml Gwemmen� F�ance
INSTRUCTIONS: See raverse side for filing instructions.
FORM YE�
HC
�
I(VJe) / V� 1 certify that I(we) oc/c�u�°r�eA as my (our) prindpal
place of residence or am (are) buying Ihe fol �ng described real property for which a Homeste d Property Taw�da�dE"edG�Cn is hereby daimed
r �
untler mnVact on Ne date this application is filetl, (data of filing): �NiY AUDITOR
❑ I(We) own ❑ Am (are) buying under recorded conVact (3�Q98N P+0
❑ Am (are) entltled to occupy as a[enanFStockholder of a cooperetive housing corpora[ion
� Have a beneficial interest in the wst or the right to occupy ihe property under ihe terms ot a qualified personal residence Wst
Sodai sewriN �umber of ' ( �l�s d'g3s)
Name aimanCs spouse (
Remrd number
Ta�dng disirid (riry, lown, townsAiP)
Pa9e
Leg tmn Is Ne p�operry in Question:
�' ��D ��l � ❑ Real property ❑ MnuaOy assessed mobile home (IC 61.7-n
I Ne revdenWl sWCWre or iha lar�d not exceedi'g one (1) aae Ihat irtvneEiatety wrrountls Uial sWCture is use0 W p�otluce inoome, desalbe Ne use anC portion
utifaeC to produca iMOme.
Township
I hereby certify ihe above statements are We, correct and complele.
dry. state. antl LPCOae)
. �Y171 � 1�1 d
%Land not eYCeeding 1(one) acre Immediauty
surtoundin residential im rovements.
Other land
7atal land (line 7 Plus line �
ResldenUal Improvements or Annualty �elling
Psscssetl Mobib I Manufacturetl Home Garage
Other improvemenis
Total improvements (line 0 Nrough line �
7ota1 value (line 3 pl�s 1lne 7�
I hereby ceRify the above is We, corted,
and complete.
Vaifying action - Signabire o(lwtliWr
i�)
(2)
(3)
(4)
(5)
(6)
20 _ pay 20 Lesser of 60% ot [he assessetl value of ihe homestead or $45.000
Nofwithsfentling any atherpmWSion, ihe wm ol the deduc�ions pmvrc/etl in IC 6-f. f-f 2 to a rtmbtie Irome Nat is
rot assessed as real propeily a(o a menuleclwad hwne Nat is not assessed as �eal pmperry mey rrot eaveed
.v�n-IwN /1/JI N fhr acu_ecea vdlue af the mobdeliome w rtNnufdLtuRd homB.
3
TownsNp
Da:e signed (monfh. GaY. Y��
Date signeG
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