HomeMy WebLinkAboutHomestead_Fergusons,"'" E CLAIM FOR HOMESTEAD PROPERTY TAX
_ - STANDARD / SUPPLEMENTAL DEDUCTION
� State Form 5473 (R72 / 6-09)
�O = Preuribed by Ihe Department af Imal Gmemmen� France
INSTRUCTIONS: See reverse side tor filing insfructions.
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FORM YE�
HC10
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I(We) � certify ihat I(we) o¢uptetl As my �gt�y8indpal
place of r dence or am (are) buying the following d ribed real propeAy for which a Homestead Property Tax Standard Deduc[ion is hereby daimed
und niracl on �he date lhis appliptlon is filed, (dafe o/filing): �� ��/
/�-�,
I(We) own ❑ Am (are) buying under recorded conVact Q P
❑ Am (are) enGtled to occupy as a tenant-stockholder of a coopereUve housing corporation C'�BSON COUNTY qUDITOR
❑ Have a benefiaal interest in ihe Wst or the right to occuDY [he property under Ne tertns o! a qualified personal residence Wst
of daimant (last frve d'giLS)
Sodal Securiry number of ciairtiam's spouse (lasl five dig'rts) I Drivefs licenss / Identl(ratbn I Oihe
ot daimanfs spousa (lest frve dgits)
116uying om m�iract, Fce Simple ownets name
RecoNefs otfifc where mntract is recor0etl
�nry I iownsnip
disirid (city, rown, rownshiP)
Iswifg State
Remd num6er � Page
� V' V{�V J�VV l�{ti/V`W'{,/� Y 4� U I IS ❑ Real proPenY �� ❑ AnnuaOy essessed modle home GC 61.1-7)
portim of Ne residential sWCWre w 1� IanC nol exceeding one (1) arze Uia� immediatey wrtounds ihat swcWre k useE to protlure incama, dascnbe ihe use and portion
P�operty utir¢eE m praduce income.
Counry
7ownship
I hereby certity Ne above statemenu are we, cortect and complete.
Pd (nUmbe+entl streef, aly Sfefe, antlLPCOtl
2� 5 f. w��r,r St,��-
. .• .
Land not exceeding 1(one) acre Immetltalety
Olherlantl
Total land (line 7 plus line �
Resltlential improvements or M
Assessed Mobile I ManufactureA
Other improvementa
Pfin��
Dwelling
Garage
Total Improvements (llne 4 Niough line 6j
Total value (line 3 pl�s Ilne n
I hereby certi(y ihe above is true, cortect,
and comple[e.
lvityin9 acflon - Signature ot Auditw
��)
iz)
(3)
(4)
(5)
(6)
�)
(B)
Sigriature ot Assessar
Counry
20 pay 20 Lesser of 60% ot Ihe assessed value af ihe homestead or 545,000
fJplui�hstandirg any atherprovision, Ihe sum d the tletlucUons providetl in IC G7.1-12 ro a nabde home ihaf is g
rpt assessed as real properry or (o a menufacfured hortie (hat'a not essessed as ieal pmperry mey rwt exceed
rvix-haH If/11 d Ne aisescetl rdlue o1 fhe mObi/e �ome or manutaGU�ed hOme.
Toxnshlp
(mrnN, day, yea�
Date signed (monih, CaY. Y��7