HomeMy WebLinkAboutHomestead_CowlingCLAIM FOR HOMESTEAD PROPERTY TAX
__ STANDARD / SUPPLEMENTAL DEDUCTION
' State Fortn 5473 (R73 / 12-09)
� yw � PresaiDed by the DeparimeM of Loral Govemment Finarm
INRTRII(:TY(IN.S� Cow mvarcn e7An fnr fi/irvi in.dnir.lians
FORM �R
1
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I(We) certiry that�(w_\e�ooap�as\�my (our) prindpal
place of residence or am (are) buying the followin described real property for whirh a Homestead Properry Tax Staridard Deduvtion �s hereby daimed
urder contrdG on �he date this appliration is filed, (date of filing). I(YVe): v R
❑ Am (are) buyirg under recorded conUSCt
GIBSON COUN7Y AUDITO
Am (are) entllled to occupy as a tenant-stockholder of a cooperative housing corporation
❑ Have a beneficial interest in Me Wst or �he right to ocwpy the property under ihe tertns of a qualified personal residence Wsl •
❑!vn (are) the shareholder, partner or member of the en6ty ihat owns the property.
•- • •
Namo of daimar�(�gal name) �
/0/
sooal semib �
sodai sm,riry numex of aa�a�rs sPa,se �wsr rNe a,yus) Drfvers 6mrea / Wentlfiq�ion I Wier number issw� s�e
ot tlaimanYs spause (last five d"gds)
� �-� �
If 6�ry'vg on contraU, Fee Simple ownets �ame
RemdeTS ofiice where conhars is recorded Record number Pape
..�. _ � . � .
Counry TownshiD Ta�dn9 � � �P)
Parcel wmber Legal tlesaiPtion y y � Is P�P�Y in 9uestion:
1 property � AnnuaOy asussed rtwb0e home (/C Gt.1-�
If any portion of the residenUal sWcture or tt�e la'W not exceeding one (1) a that immed tey su nda Ihat sW mre's used m produce inmme, tlescribe the usa aM portion
of the poperty uti0zed m pradure Income.
�a� -�a -� �-�o � cn a � �� o a �.
... . . : . .
Counry Toxnship Cu�b T��P
I hereby certify Ihe ebove statements are We, correct and mmplete. Signawr aimant
� c%��l c� S�e�� S�-'� P,-f n c�f-c�n ,/�J 47 �D
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Land not exceeding t (o�re) aae Immediat¢y .. ' �a- ��} ..��`� � �r ' - •''"
wrtoundln resldential Im rovements. (�� � =� -t ` ����~x: ,
,sf::.:`Y,. =.X'
�e- �c�e� -w�.-'e
Other land (2) � ,.. � �"> �'��_
Total land (line f plus lilre � (3)
Ruidentlal Improvements or Annuafty �����9 (4� ��"�;� ��4 $ '��`f ����"1
Assesaed Mohle I ManufacNted Home `�=-'�i %�'"-'a �-+-�rt i=
Garege y�.ro � :� - s r ....zz
�5) � <..-.iz.z;__.5�. �..�..i>...�5
�IhBfITPlOVBt1181115 �6� �"g f-r+l��,-�-Y�j�.•�"
Total improvemert[s (line / through line � (7)
Total value (line 3 pJ�a One � (B)
I hereby certify the above Is We, eorreel, �9^awre of Assessor Oate signetl (month, dey, yea�
and eomplete.
Vaiy'ug aUion - SigmaLire oflwdibr Date sigred (mrnth, daY. Y��)
� . - � � • • •
�_ pay 20 _ Lesser of 60% of the essessed value of the homestead or $45,000
Nolxilh5fanding any oNerprovisiwi, fhe wm o/Ne deducfions provHed ln IC 67.1-12 ro e moW7e hane that is $
nof essessed as reel pioperry w ro a menNactwed home fhat is not essessed es 2al proparty may rrof ezceetl
wre�hall (1/1) al Ure essassed vehre h mobde home wmenufecfured home.
Signawre of Dete signetl (monN, daY• Y��)
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