HomeMy WebLinkAboutHomestead_Davis (17)"'" CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTAL DEDUCTION
��r` State Fortn 5473 (R12 / 6-09) .
�O � Presaibad by Ne Departmerrt of Local Govemmefrt Frence
INSTRUCTIONS: See reverse side for filino insmations
FIL
OCT
;1 ',.�;
•
YEAR
. �
� �(�"�e) N CQ��h�r(v �) xwpied as my (our) prindpal
place o( residence or am re) buying the tollowing described real property for which a Homestead Pmperry Tax Siandard DeduUion is hereby daimed
under mniract on the date lhis appiicalion is filed, �. (date o/filing): .
�(We) own ❑ Am (are) buying under recorded conVact
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperaGve housing corporeGOn
� Have a beneFicial interest in ihe Wst or the right to occupy the property under the terms of a qualified personal residence Wst
•• . •
Name of dairtant (kgal name)
C qV�
Sadal
Nama ot da' Q C s� (�neme) � /'1 �'
i� J
Soual Seauiry rnimber of daimant' sparse (las( frve dig'RS) Dm�ers ficense / identifiration I ONer number issumg
����=��,�
. ... ,
tl Wy'vig on conhact, Fee Simple owfrels r�ame . '
Retortlefs Ol�ce Mrere contraU is remrGeE Remrd numbu Page
'"�. . � . �
�nry Toxnship � Ta�arg disbiG (cily, to iP)
Parcel numher 0� Is Vie mD�Y in W�tim:
� �� v�venr ❑ a,�uauy assessed rrrowe t,rn,e (�c c-�.+-n
� �i any portion of Na residentlal swcwre « �Ae lana not e:cee0� one (1) aae that Immeeiatery surrourMS ihat structure is uuW m pmEUCe 4rcnme, des`ribe the use aM poRion ,
of Ne pmperty uri�eE b pmtluce inmme. '
� Co-� a-a -7- 205' -ood�Lj %/� - U a 8�
-.• . ,: . .
Cau�ry Township Caunty Trnmship
1 hereby certify ihe above ststements are we, cortect and complete. Sigriacura ol daimam �
Pddress (numDer an0 slreet �Y. slete, aM LPtada) .
�. � � • .� • �
i�'. •
I.and not e:ceeeing t(one) acre immediatety � .`�4�� �+9�,`'-`� ��`'���-�
sunoundin resitlential im rovements. � � .r,T�' �T��P ��-�,
a
Other land . (2) . � ��y,.�`�,``?z�' ��
Total land (line 1 plus line 2) (3)
�� -g �
ResidenUallmprovemenborMnualty ����ng (4) � ��§"-.�,�2�-,�:2�.'��� _��7��
Pss�sed Mohik I Manufactured Homa - `,��..'`�"' "Y' �°�"x..�3�'�;x'Y'�
Garage (5) ;"r,��j a-�'_w^'�,.'��.'':��.�`�
Other improvemertts ' � (6) ; w;� �� �
�� �:���:
Todl improvemenb (line 1 fhrougAline � (7) �
Total value (llne J plia llne � (8) �
1 here6y certiy Na above is we, cortect, Signawre otAcussor Date signea (monM, day, year)
and complet¢.
Vailyin9 aUbn - SignaWre ofluidtor Date signed (rtronth. tlay, yea�
� � . - � � � • �
- 20 pay 20 _ Lesser o( 60% ot the assessed vAue of Ne homestead or $45,000
NoM1�iMSGind"ug eny oNeiproNSim. Ne sumWlhe deducfiwu prosided in IC 61.1-12 m a mo6�e fpme lhat is S
nof essessetl es �eal poperty a to e marwlacmied horne tha('a rot assessed as ieal properry may rat exroed
one-heH(72) d Ne essessed relua dNe mobde home w manu/aflure0 Mme.
Signawre al PuBtor Date sig�d (monN. daY. Y�1
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