HomeMy WebLinkAboutHomestead_McIntosh"'' CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD/SUPPLEMENTAL DEDUCTION
S State Fortn 5473 (R12 / 6-09)
�' � PreunLetl by lhe DeparimBM of Loml Govemmenl Rrmnte
F EAR
JUL 2 7 1011
IN51IiUG IIONS: See BVCrse SM¢ 7of filUg InSfIUCtl005. ' �` �
� /� � � �� •
1(We) Q., (.L��� C certify fhat I(we) ocwpied as my (our) prirkipal
place of residence or am (are) buying the following described real property for which a Homesiead Property Tax Standard Deduclion is hereby daimed .
under conUacl on ihe date Ihis appliration is filed, (date ol filing):
�I(We) own ❑ Am (are) buying under recorded contrad .
Am (are) enGtled to occupy as a tenant-stockholder of a cooperetive housing corporation
� Have a beneficial interest in the Wst or Ne right to occupy the pmperry under the terms af a qualified personal residence wst �
.• � •
Name of dauna legel name) � e / ^ .
�YQ J
Sodal Seaviy
Name of daiman spouse (lapal name) /� e n /
VL �[C.7u
Sotlal ry m�m0er of daimanfs spouse lasl five dgds) DrNels Gcense / ICentifration I
/
{
• ••� �
It Duyuig on contract, Fee Simple owners rame
Reoorders office where mnveG is reowde0 ' � ' Remd numher Paqe
..�. . � . �
���y Township Ta�dnp d�strid (fily, town, Mwnship)
PerrnJ number Legal Ae�saiP� Is Ihe pfoperry in queslion: � '
' � Real property � MnuaAy essessetl moble home (IC 6f.7-7)
�h e�Y Portion d Ihe �etiAential SUUCWre n Itre IarM nOt ezce�4�9 orce (7) aae Ihaf mvnetliately wrtaunCS Nat 6WCNre Ls used In P�uce irmme. aestnbe the u58 and poRbn
ol tl1e pmperty UGT¢Ed tD pmOUCB i�dna.
o?G -/a-Q _ o�- 6o.3_ �S�i - 007�
-.. . .: . .
Counry Township ' Counry ' Tow�sship
)
I hereby certify the above stetements are We, correct and complete. Signature o1 daim� C / J�
i I
AEGreu(numberarNStreef,tlry,state,antl a) �
�la� �� r� � � ��`nc�� `� '-�?b��
,. , � . .� . ,
�� .. '
Land not e:ceeding t(one) acre immediatety y�;`..�`' � '!��'��`{�` -�
surroundin resitlentialim rovements. (�) �:� Y��:,x.. °.3���
Other land (2) "`",'�3.��':vi'y;�'�-�'.�. =N? �. .
ToUI land (line 1 plus line 2) (3�
ResidenUallmpmvementsorMnualty 9 (4) '���t3�w����'��-���i
Dwellin ,F_ „�. .} ,,� ,� �yY_-,
Pssrssed Mohik / Manufachired Hortro Gara e (5) ^'`�`�%`�%r� }v •'��i�-� y° kv =
9 q.i.u'�`;e*1"?'i.��s�yy�'�,s
�`�:�«:.ix .
Other improvemenis (6) ��.��,,;,,�r�:,,.
7ota1 improvemenb (line I throug� IJne � (7)
Total value (line J plis 17ne 7) (8)
I hereby certify the above is true, corted, Signanue otASSessor Date signed (month, day, yea�
and wmplete.
VaEying acuon - SignaWre of Puditnr Date signed (rtronN, day, year)
� �.-� � � � •
20 _ pay 20 _ Lesser of 60% of the assessetl value of the homestead or 545,000
nbntiths7end'vgenyoNerprovision,NewmWMededucliaupro�idedinlC&f.f-121oamob�efpmelhat6 $
lqf 855BSSCd 83 /B8� plDpB/Iy 0I i0 8 lllBll(/fdL((//B(� i1MlB lil8l6 (10� 8558558(� 85 /BB�pIOpBllylll8j�l101 EXL9B� �
o���,en��rz� dma esse�ssad �nre dnre,maae no�,e w�r�a�waa��ed no�r�e.
Sigriawre ol �iw Date signed (monfh, day, yea�