HomeMy WebLinkAboutHomestead_Doyle (3)"'" CLAIM FOR HOMESTEAD PROPERTY TAX
:,.._,. ? STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R12 / 6-09)
,S � Prescribed by I�e Department ol Lool Govemment Fnance
INSTRUCTIONS: See reverse side (or filing instructions.
� � � ..- , � ��l�
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i(we) cenity that I(we) oaupied as my (our) prindpal -�
lace of residence or am are bu n the followin descri6ed real ro e which a Homes[ead Pro e Tax Siandard Deduc[ion is hereb daimed �
P ( ) Y� 9 P P nY P rtY Y ,
under conVact on ihe date Uis applinUon is filed, (date of filing):
❑ I(We) mm ❑ Am (are) buying under recorded conVad
❑ Am (are) enlitled to occupy as a tenan4stockholder of a cooperetive housing wrporation
� Have a beneficial interest in ihe Ws� or [he right to occupy Ihe property under the tertns of a qualifed pereonal residence Wst
Name ot daimam (legal name)
. r � .
Sodal SeariN rvur� d d
�
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tt buying m mnYact, Fee Simple ownels �me
RecoNeYS otfice where conVact is recoNed
�nry I Township
ol Uaimant (lazf �rve dg'
I Issuifg State � �
Issuing State
Recwd num0er Page
rown, towrtUiip)
Pa�crJ numher I�9aj� � d�P�{�1 _ /� / I Is Ih�PenY in qunstion: ❑
[�/�d.0 �%a.v c2� 1���. r j R I ProPertY AnnuaOy assessr� mohil hom (IC &f 1-7)
If any portbn of Ihe residential sWCture or Ne land no� exceedirg me (1) ane that immediately surrounds Ihat sW cWre is useA to pm�uce Incoma, descnba Ihe use anE porum
� of Ne properry unT¢ed to proEUre inmme.
,��0-/d-o7 -/od-oo�. 779-�aS
Township
1 hereby cert'rfy the above statements are We, correct and complele.
AAdress (numberantl slreet, ttiry, 5fafe, antl
Land not esceeding 1(one) acre immediatety
surtounding residential improvements.
Otherlantl
Total land (line 1 plus line �
Dwelling
ResltlenUal improvements ar Annualty
Assessed Mobiie I Manufactured Hane Garsge
Other improvements
Totai Improvementa (line d through line 6�
Total value (line 3 plla line n
I hereby certify ihe above is true, cortect,
and complete.
Vaifying action - Signature ot Auditn
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�2)
(3)
(4)
(5)
(6)
IB)
Counry
oi tlaimant
20 _ pay 20 _ Lesser of 60% of the assessed value of the homestead or 545,000
Ablwi(hslaMing any other piovision, fhe sum o/ the deCUCfiarts prmnCed in IC 67.1-f 4 W a mobde Mme ihaf is
rrof essessed es real property a lo a manuleUUred home IAef is rat assessed as reel properry may nof exceed
nne.IwN/fnl NNe ascr_csed ve/ue o1 fAa mobile Mme w manufaUUiatl horx.
5
r�wo
0
(monfh, day, yaar)
Date signed (monlA. CaY. Yee�
Y��)