HomeMy WebLinkAboutHomestead_Dewig (3)" CLAIM FOR HOMESTEAD PROPERTY TAX � FORM YEAR
� CREDIT/STANDARD DEDUCTION ( � (� �� � HC�o �
` ' State Fwm 5673 (R8/7-07) y \
�. Prescnbed by Ihe Dapartment of laal Govemment Fviance �
INSTRUCTIONS: See reverse side for filing ins6�c6ons. �{ �� ���
��e) certify that on the 1 it'�1 oTN��_
I(We) occupied as our prindpal place of residence the toibwin desuibed real property for which a omestead Property Tmc Credit is hereby dtimed:
�I(We) owned ❑ Ne buying under contraG Q`���� �7f� ��
Have a benefiaal interest in the entity that is liable fw the property taxes on the property and that owns th p�r,a_ _ trad.
It Wying on con4ap, Fee Simpie rnvnefs rreme
canUad is recarUed
Counry Tawruhip
Parcd number � al dq�cnption
�
tt arry paUon of Ihe rasidential swcWre w ihe land ot e i,
of Ihe property uli0zetl In pmduce inwme.
��-�a-o�-30
ihal im�ately surtamds
�
Record number � Page
jy, fown. townshiP)
1�
propertyin quesUon:
�R al property ❑ Mobile Home (IC 6-1.1-n
sUUCture is usetl b produce tr�wme, deunba �ha use and pwlbn
... . ., . .
County Twvnship County 7onnship
I hereby certify the above statements are true, wrrect and complete. Siqnature of daimaM
l.�
/�
dress (number and strest cdy; sfate, end LP code)
�a�-1 S. LUQS�R�� lh �i QC.v'll Phc�t'� 1N �i%�o7�
•- •
� � .� � �
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Land not exc�rg 1(orre) ave irtvnediately � a .+` -:.'3 -°- �`^.
wrtounding residential improvements. ��� - - - _
ONer Wnd 't
(Z) . �
'� '� -
Tdal larnl (1'me 1 plus frne 2) �g�
c .
Residentialimprwemen4sorMnually �Ilin9 (4) � ' ,`u+` � a-�rs-:t,,,'Y t �.;.
AssessedMobilelManufach�redHome �? , 4-_��{��,�yX-� .�r �
Gara9e (5) �Y 7 p���'ie� ,c.:n p 4' -
:li��-3•.cr.e'r.� '
Y 5 ': �
O�herimprovemen45 (6) E '� :.;�.a�'�,a; �.��
-��,�-s�u..
Tdal improvements (I'me 4 Uvo�gh Gne 6) �7)
Tdal value (line 3 pl's lirre n (g�
1 hereby cartify the above is true, correct, and SigrreWre otASSessa Date signed (monN, day, year)
complete.
VeiNin6 action - Sqreture M Audnw Date signed (month, daY• Y��
�•'� � � � •
PeY Z� — 45.000 for 2007 pay 2008 42.000 for 2010 pay 2011
Lesser of 12 qq.000 for 2008
Homestead Vaivatim P�Y Z009 4 �•000 for 2011 pay 2012 $
a 43,000 tor 2009 pay 2010 40,000 payable after 2072
SignaNre of �tor Dafe si9ned (month. day, yea�
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