HomeMy WebLinkAboutHomestead_HumphreyS"'" � CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD/SUPPLEMENTAL DEDUCTION
State Form 5473 (R72 / 6-09)
�9 � PrescnbeC by Ne Departmenl of Loral Govemment Friance
INSTRUCTIONS: See reverse side (or filing instructions.
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NOV 1 3 2009 �
i (we) - cen�h ��1 �.�s R,S'Et1Mtis��daai
place o( residence or a(are) buying the tollowing de 'bed real pr erty for which a Homestead Property Tax Standard Deduclion is hereby daimed
undei mntraa on Ne [e this applicalion is filed, (date of filirg):
❑ I(We) own � ❑ Am (are) buying under remrded wntract
❑ Am (are) enlitled to occupy as a tenanFStockholder of a cooperative housing corporation
� Have a beneficial interest in �he wst or the nght [o occupy the properry under Ihe terms of a qualil�ed personal residence Wst
�rivel5limnse / I
Name of tlalmani'
Sacial Se�vriry numbu ot tlaimant's spouse (Wst frve d'gds) I Drivels licensa / IAentiflcation / Othe
of da'unant's spouse (las( frve dk,7its)
M buying on wnVaU, Fee Simple o.mefs rume
Counry
Township
PatWnumber I eldesniptlan �� IIsNe
�+ t �
It any portbn ol ihe residential sWCW re or Ne IaM not azceedirg me (7 ) a�re Nat immetlialey surtaunds
of Ihe pmpeny uuT¢ed to P�uce inmme.
d-�-ia-o�- 30�_000. �i 8y-oa-�
Crnimy
Trnmship
1 hereby certify the above statements are We, corted and complele.
AEdress (iwm6ei aM s1
�
Land not exceeding 1
surtounding resident
Olherlantl
tlry, sta.e,
acre immediately
Total land (line 1 plus line �
Residentlal improvemenLS ot Mnualty �Iiing
Assessed Mohila I ManufacWred Home Garage
Other impmvements
Tofal improvements (Ilne 1 Mrough line 6)
Totai value (llna 3 pl�s line 7�
I hereby certify lhe above is Irue, cortect,
and complete.
✓erifyifg actian - Signatura of Auditor
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(Z)
(3)
(4)
(5)
(6)
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Slgnature o/ Assessor
Caunry
I1�� �� / �
Issuing State
Remrd numCer Page
town. (ownshiP)
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�perry in queSGOn:
'�� woa�r ❑����Y assesseL modle hane IIC 6f. f-;
i[ sWCN2 i5 u5ed N ploduce imm�e, EesCnbe �he use aM por0on
.
r�mo
20 _ pay 20 Lesser of 60% ot the assessed value of the homestead or $45,000
Nolwit�slaMin9 eny aherproWSion, Ne wm o11he dadutti�ns provitletl in IC 6-1. f-f2 to e mo6de home Nat is
nat assessed as real propeily a(o a menufarlured home Net is not asse.ssed es real property mey rwt esceed
rvia-hnH/f?I a{Me assesse� value o/ the rtpAde home w manu7d�tured hame.
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Date signtd (monN. tlaY. Y�A
day,yea�