HomeMy WebLinkAboutHomestead_NesbittCLAIM FOR HOMESTEAD PROPERTY TAX
_ , STANDARD/SUPPLEMENTALDEDUCTION
State Fortn 5473 (R72 / 6-09)
�� � P2uribetl by Ihe Department M Loral Govemmerrf Frence
INSTRUCT70NS: See ieverse side /or filing insVVCtions.
F YEAR
� HC
MAY 4 2011
� I(We) • ' certify that I(we) p as my (our) prindpal
place of residence or am (are) buying the following described real property fa which a Homestead P�Q�c �i+i�r�l��ri�hereby daimed
under mnVact on Ne date this appiicallon is file4 (data of filirg):
❑ I(We) own ❑ Am (are) buying under recorded conVaa
❑ Fvn (are) enUUed to occupy as a tenant-stockholder of a cooperaUve housing corporation
� Have a benefidal interesi in the wst o� the right to occupy the property under the tertns of a qualified personal residence wst
.• • .
Name m( n �
�K
� ����� �=�,b��,�"�
Name M �
SoUal Seaviry m�mbr of tlaimanCs spause (last frva dgds) D�ivels Ocense / Identifration / Ofher number � Issu4g Saie
of daima�rt's spaue (last frva d§ils)
• ••� �
tl buying m mntract, Fee Simple o.meYS �me
Recordefs ofice where conVSCt is recorEetl � Record number Page '
..�. - � . �
�nry Township Taxing Qatrict (rity, town. township)
a� ���.��04-000. oad o�, ,so m���,:
�,
— � Real property ❑ MnuaOy assesseA modle home (IC 6f. f-n
'If any pw[ian W Na fesMential sWCW re w 1he Wnd nU eseedtrg me (1) aae that Mmediately su�mu�Ws that shuc4�re is used to produm iMana. Eescnbe Ne use anA portion
of Ne pioprlty WTaeE b pradure inrrnne.
• � • • � : • •
Coumy Trnmship � ' Counry Township
I hereby certify the above ststements are We, corteu and complete. ��� i '
Pddress (number arW slreet, ciry, sfate, arM LP code) .
�• •
� • � � • �
i� . •
Land not exceeding 1(one) acre Immediatety 3�'� �'� �v�'��`-��`��'c ��
surroundin resltlentialim rovements. ���) r.w��s"����.v%a.�.r+�:.��kc:-�x
�;��i'-,�r� t .
ONer land (Z) C�._,.': i;::.!��. ,
ToGI land (fine 1 plus line 2) (3)
-;+c -5 ,�tp �.g
ResidentiallmprovemenborMnually �����9 �4) y°'�,�`^����s��;��'W �
0.ssessed Mo6ile l Manufac4+red Home g �5) F�> '� "��� �'�"y`�� e
Gars e � se.�tv��l`P,-r.�v�.-.�.���'
>��`��'�{':�=��
Other Improvemenb (6) � :%i'.<.:��'.;;rt-0�..�L i
Total Improvemenb (Ilne 1 througAline � (7) '
Total value (flne J pl`s Ilne 7) (8)
1 hereby tertify the above is We, wrtect, Sigrawre ofASSessor . Date signea (month, day, yea�
and complete.
VailYin9 action - SigreWre of Puditor Datc signed (rtpnlA. daY. Y��)
� � • " � � � • •
20 _ pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
NohVhWMCg anyotherpo�isinn, Ne sum W the dedtxl+ens proNdeC in /C 61.7-72 fi e mob�7e home IAat is $
na assessed as ieal property w Io e menufeUUred harie Ne( is inl assessed as reel propeRy may rwt eroaed . - �
one�hatl (12/ d fha assessed value o7Ne mobde Awne wmanNacfuretl hortie.
Sy�ture W Pudrtw Da1e sgned (month. daY• YTa�