HomeMy WebLinkAboutHomestead_Groves/1,�� �
l J
"'" CLAIM FOR HOMESTEAD PROPERTY TAX
S, ._ = STANDARD / SUPPLEMENTAL DEDUCTION -
State Form 5073 (R72 / 6-09)
�O l Preuribed by the D¢partm¢M o{ La�l Govemme�ri Frerce
INSTRUCTIONS: See reverse side !or filing instrtictions.
4 ' E'e
i•' :� :i,: •I i-��
� 11_
;�•,
I(We) ceAiry ffiat I(we) occupieC as my (our) prindpal
place of residence or am (are) buying �he fo lowing described real pmpeRy for which a Homesiead Property Tax Standard Dedudion is hereby daimed
untler mntraG on the date this appliralion is filed, (dale o/fi/ing):
❑ �(We) own ❑ Am (are) buying under recorded conVaa
❑ Am (are) entitled to occupy as a tenanastockholder of a cooperetive housing corporetion
� Have a beneficial interest (n Ne Wst or the right m occupy the property under ihe tertns of a qualified personal residence Ws[
Name
Social Securiry numbei ot rJaimanYS spouse
tl huyin9 ����1 Fee Simple ownefs riame
Recordef5 af&r wtre2 mntraq i5 iecuded
Couny � Toxnship
Drivers ficenx / IEentifretion /
OmeYS license I Itlenti(xalion / Other number
or aaimam•s sw�� (�s� rrve dgilsl
2 r�
Record number
Page
Paroei number egal desaiption n �._' ? Is Ne m Question: � -- ---
� � L�.O�O� ��7 Real pmperty � MnuaOy assestW mupfle hane (IC 61. f-n
If ny portion of Ne resldential sWCwra or Ne WM nol exceading orre (1) ave Nai immadiaiety surtounds �hat svurtura b useE to pmduce Income, Oescn6e Ne use aM portion
o the P�PeM uotaed to P�uce incoma. �
�(o�la-o7-yo3-oo3. ss7-oa-8
��ry
T�„�n�P
I hereby certify Me above stetements are We, corteU and complete.
riry, slete,
Land
ONer lantl
ToGI land (line 1 plus line �
Other Improveme1rts
acre immetliatety
Dweliing
Ga2ge
Tofal improvemenb (Ilne 0 thmugA Ilne �
Total value (Ilrre 3 plts line 7)
I hereby certify the above is We, cortect,
and complete.
Vaifyi� amon - Signature MPLdtw
�
TRUE TAX VP
�
(Z)
(3)
(4)
(5)
(6)
(8)
Signature af Asscssor
Caunry
N y�7c�`7D
20 _ pay 20 Lesser o/ 60% ot Ihe assessed value of Ihe homestead or $45,000
NofwithslarM6g any a1he�P���. Ne sum W the dedurlia�s prouidetl in IC 61.7-12 to a mobde7qme Nat k
nW essesseC es ieal poperty w to e manNa�red lrortie Nat is rot assassed as reel property may rpt erceed
ono-hetllf2l W tha assessed re/ue W Ne mo6ie fwme w manufarlured home_
S
Township
Date signetl (mmt�. OaY. Y��)
(rtanfh. daY yea�
��