HomeMy WebLinkAboutHomestead_Rish" CLAIM FOR HOMESTEAD PROPERTY TAX
rt ; STANDARD / SUPPLEMENTAL DEDUCTION
S � State Fortn 5473 (R72 / 6-09)
�O � Prescribetl by the Department of Lo�l GwemmeM Fnanca
INSTRUCT70NS: See reversa side for filirg instructions.
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JUN 8 - 2010
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� �'�'e) cef;rti I�DIVlb�1��) Pri�pal
piace of residence or am (are) buying the following described real property fw which a Homestead Propeify a�ndard Deduction is hereby daimed
under contrad on ihe date Ihis appliption is filed, (date o/filing):
�i (We) own ❑ Am (are) 6uying under recorded wnVacl
❑ Am (are) entitled to occupy as a tenanFStockholder of a cooperetive housing corporauon
� Have a beneficial interest in Ne Wst or the right to occupy the property under the tertns of a qualified personal residence Wst
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Nartre of Uaimam (legal name)
So�l Senuay mc� of dav�ant (last fise Qqds) Drivers ficense / Identifintion /
Social Sewnry numbrr ot dalmant's spouse (last fiva digits) Orivefs licanse I ICentifration / Oiher numCer Isw"vg State
ot daimam's spousa (Wsl frve dgits)
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If buying om m�trac� Fce Simple ownels �ume
ReCONels office where conVaq is recortle0 Recor� numbu Page
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���y Township Tarirg disiria , town, township)
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Parcel num6er Legal tlescApUon Is the peoperty in queslion:
' � �'� • �S perty ❑ MnuaOy assessed rtwbile home (IC &1.1-n
�It any partim of Ne raziden�Wl sttudura a Ne Wnd nol eYceeding orre (1) acre Nat Immediately surtounds Ihae swmra is useC m pmdure income, desrnbe Ne use and portian
of Ne property uGf¢eC to Pmtlure incame.
a�-ia-��-30� dda o59-oa �
... . , : . .
Counry Towns�iP Counry Towrts�ip
I hereby certify ihe above ststemenu are we, correct and complete. Signaeure m �
Pddress(numberantl9reef,ciy,sfate.andZ/P � � �
6 � �
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Land not exceeding 7(one) acre immediately �.�`-zi �^ "i.'� ;%� ���*�"
surtoundin re5identialim rovements. (�� �: ��-�.=SYr"'�+.`ri�s. �'.�_'"-�'�
3u�._j�.M'i��::w�^if�y}§ .
Other land (2) 's,'.'-".-.sd'.:,;s'?f.^;"��
Total land (line 1 plus lina Y) (3)
9 (4) � ic^'2S�'- � ..,�sr�
Residentlal improvements or Mnuatty ����� �''��'x�� `�z�'� #� Y'°E--
0.ssessed Mobik I Manu(acturetl Homa Garege (5) `�^' ��� �'��"� �`�"��`�s
.s�.�-r+£:_ � �-�w- �r x .,�?.:,.:
....-}:,:.-... -,,._:+,:e _
Otherim rovements (6) ' ��1:'.'-^°��'����'„
P :x...1 � , . _�!.:t'
7otal improvements (line a thmugh fine 6) (7)
Total value (line J pl�s line � (8) .
1 hereby certity the above is true, cortect, Sigriatura of Assessor Date signm (rtimth, tlay, yxar)
and complete.
Vaiiyi� action - Sigranire of PUdirur Date si9�C (rtronN. daY.1'��
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20 _ pay 20 Lesser ot 60% of Ne assessed value of ihe homestead or $45,000
Abh�4n9aMirg anY oNerP����. Ne sum d the tletl`x.lions provided in IC bf. f-11 to a mobde home Nat is S
mr essessee es,ea� yoperry «ro a menweauren rrome Ner "a na essessed es rea�wovam �nar �� erosea
one-hatl (72) olNe a5sesseU vefue o7the moDde home w manularlured frortie.
gna ol Pudiim Date s9ned (r+wrth, daY. l'ea�)