HomeMy WebLinkAboutHomestead_FletcherCLAIM FOR HOMESTEAD PROPERTY TAX FORM �
_ STANDARD / SUPPLEMENTAL DEDUCTION HC�o
` " Shate Form 5473 (R13 / 12-09)
� y� Presaibed by Ihe Department of �ocal Govemment Finance `
INSTRUCTIONS: See raverse side forfiling insWc6ons.
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I(We)
escribed real property for which a Homestead Property Tax S�rd�e�n imed
er contracl on ihe date ihis appliration is filed, (date o�filirg). I(We):
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� own ❑ Am (are) buyirg untler recorded conVect MAY 7 Z��Z
❑ Am (are) entilled to occupy es a tenant-stockholder of a woperative housing corporation
❑ Have a benefidal interest in Me wst or the nght to ompy the property under ihe tertns of a qualified personal resi�er�e��
❑ Am (are) ihe shareholder, partner or member of the entity ihat owns lhe properly. R
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Nameot t(legalneme) A �
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so� sea�
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If buyin9 on conttxt. Fee Sirt�e owners name
aemraers oxce w,ere mmrsa �s recorded Recard numbes Paqe
..,. . , . ,
Counry TamsliiG Tabrg distr'xt (ciq; t . for'+W+rp)
Parcel number Legal desrription Is the pmpeny in puestion:
i%L� � T �i�i wo�nr ❑ nM�ny �a monua r� �ic �-v �-n
It any ponion of the revdential sWCture w the farM rat exceeding ona (i) aae ihat immediatey surmunds that strutlure is used to produte income, tlesaibe the use arW pation
d Ne P�WanY utIDZed lu yotluce Nmme.
��-�a-o�-yo�-oo a. a�v-o�.8
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Caunry Township Counry 7ownsNp '
I hereby certify the above stalements are Vue, correct and mmplete. n�re ot da' ant �-?
i
ress (numbe� eM sLeet, city, uare, ard zlP mCe)
a3� 5_ Se � . �r�r�e.�on S �t� �l�
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Land not exceeding 1 (orre) acre Immediatey ' � ��s�,r � "r�� '� �: °n f-�,
� . {: �.a . � .-Y�a _ �iv. n'�3 9 ^.`s�
SurrOUndln realdentiaf im roVemeMS. ( � _'�.
�' s �l� -e
Otherland (2) ,�`�,'�_� _ .�;��,,.;,.
Total land (lirre 1 plus line 2) (3) y�
�'s��'t� �'Xw :'r..ki^�w�.s�.'�r':�
Reside'rtialimprovementsorAnnually �IIIn9 (4) �;��- ' b��,�,,,7r p{�_;,�¢,�
Asvesaed Mobtle I ManufaeNred Home G�9e (5� .i+"'-:�T„ ^yc'*� ya��=z�,�'�'�"k #�.
:s � _ .5..�`s':`kk` "4+:�1 '
ONar Improvements (6) �} � sx'+ss'-��"" -`�� � �
7otal impmvemerKS (line I Nrough line � (7)
Total value (Ilne 3 p!`a line � (8)
I heraby certify the ebove Is true, corteet, �B^a�re of Assessor Da�e sl8ned (month. deY. i�A
and complete.
Vaifying adion - 35��re af Auditw Date sigrred (monN. daY• 1'��
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20 _ pay 20 _ Lesser of 60% of the essessed velue oi the homestead or $45,000
No�withstand'ug anY otherpmvision. (he sum W Me deductbrt provkietl in IC 61.1-72 ro e rrnbde home Ma1 is $
rat assessed as reel property w to e menufactured home Nat is nol assessed as 2el pioperty may rrot ezceed
oneAatl (f/11 W tAe essersed velue W the moWM home w manu/acLnetl Aome.
Signa re of NMitw Date si9nPA (rtanfh, daY. YBaA
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