HomeMy WebLinkAboutHomestead_Lashbrookd�'"'"a CLAIM FOR HOMESTEAD PROPERTY TAX
Sy,._ _ Z STANDARD / SUPPLEMENTAL DEDUCTION
State Portn 5473 (R72 / 699)
S ` PreStdbeA by the Deparimenl of Lmal Govemment Firance
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FORM YEAR
HB10
il
,,.,,R,,..,,,,,.�.,ee,���„�,,,.�,�„�,,,y,,,,,,,,�,,.,,,,. U�I 1 4 2009
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I(VJe) certity ihat'1�We�}otco�.ie�as my (our) prindpal
place of residence or am (are) buying ihe following described real property for which a Homestead Prop��� d ra Deduchon is hereby daimed
under conVact on the date Ihis applinfion is filed, - (da[e of filing): 2�UNTy AUDITOR
�I (VJe) own ❑ Am (are) buying under recorded wntract
❑ Am (are) enGtled to occupy as a tenant-stockholder o( a cooperalive housing wrporetion
� Have a beneFidal interest in lhe Wst or the right to occupy the property under [he tertns of a qualified personal residence Wst
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Name of da'unant ( 1 name) v� /
�l /} /�l La�s/7 �rod
Sodal SerLrity number d damanl (lasf fise dig.is) Dr'rvers license I Identifinlirn I Other number Issuing State
� of daimant (lasl frve d'giLSJ //
Name of daiman�'s spouse (legal name)
Sorial Seanry numbesof daimanfs spouse (last five tligr(s) Drivers lircnse / Iden6fuaiion / Other number Issuing SYate
of da'unanPs spouse (las( five dgits)
• ••� �
It buying om m�irad, Fee Simple ownels name
Recoidefs ot�ice where mnVad is recoide0 Remrd numher Page
"�• ' � • �
�nry TownshiP T2�un� disirid ( ' rownshiP)
�
Parcel number Legal description Is pm in questian:
aa �QQ � .Q I perry ❑ Annuatly awessed modle home (IC 6-1.7-�
•If any ponim ol ihe residential swcture w Ne land not ezceedify one (7) afre �hat immediatey surtoun �ha[ swclure is use0 co protluce income, descnbe the use and portion
of Ne pmperry utif¢ed ro pmduce inmme.
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Counry Township Counry TownsNp
i hereb certi the above statemenis are We, correct and com lete. Sign°�m/� r'imam (� ��� /� �
Y tY p I` )Cl_ 1i �:QYLYJ��Q'�-1�L.
'�°rew umbeiandstree(cirysfate,andZlPCOde)
�bso,� S� . P�wcs�4-or� Z,J �111fl10
.- .
. . �. . ,
�, . .
Lantl not esceeding 1(one) acre immediatety ���z �� i"�''£'�''� "�!`� �„
wrtoundin resitlendaiim rovements. ��� `"e'` �' �-�' �x �=a4-
Otherlantl (2) � >;x,.,�s,�r�e.�'
Total land (line f plus line � (3)
_f" �. � r Y -- �r..
Residendal improvemenis or Annually �ellin9 (4) "��y-�v���`£s �-s,�--�.,.,,4� ��
Assessetl Mobile I Manufactured Home Gars e "'�'� �� ��t.,} �'r `
9 (5) • .�c" z�-��..-�: �=�
Other imOrovements (6) �3 �`� «?9.i �""�:�
Tofal improvements (Itne 4 Nrough line � (7)
Total value (line 3 pLs I/ne 7) (8)
I hereby certiy the above is true, cortect, �9��ure of Assessor Date signed (month, day, yea�
and complete.
Vaitying acfion - Signawre o(lwditw Date signed (monN, day, yea�
�.-� � � � •
20 _ pay 20 _ Lesser ot 60°k ot the assessed value of the homestead or $45,000 ,
Nohvi(hslandLg any olher pmvision, the sum o1lhe deductons proWtle0ln IC 67.1-7Y ro a rtrobife Fame Naf is g
rnf assessed as ieal property or to a menufacfured home Nat is rwt assessed as real pmpeny may not excroed
one-hall (12) o/Ne assessed rdfue a/ the mobile home ormanutdcfuietl hwne.
SignaWre otPUtlimr
Date signed (monfh, day, yna�