HomeMy WebLinkAboutHomestead_Ross'� CLAIM FOR HOMESTEAD PROPERTY TAX
�, ._rt. L STANDARD / SUPPLEMENTAL DEDUCTION
State Fwm 5473 (R12 / 6-09)
S � Prescribed by the Departmenl W Lo�l Gmemment Fnance
INSTRUCTIONS: See reverse side for filirg insUUC(ions.
� �
�c oM YEAR
�
�LJ
SEN � R 2009
�(y�re) ( J�� (�(, {'�.�1. U�/�J certity that �(we)a"cEGpied a4ri�{OUr) prindpal
place of residence or am (are) buyinq the following described real property tor which a Homesiead Property Tax D �r s he�reb daimed
under mnVact on the date this application is filed, (dale of fili ��� ���'v4y AUD�iOR
�9)
❑ I(We) own ❑ Am (are) buying under remrded wnVact
❑ Am (are) entltled to occupy as a tenant-stockholder of a cooperative housing corporetion
� Have a benefida� interest in the Wst or the right to occupy ihe property under Ihe terms of a quali(ed personal residence Wst
Social Secvnry
II buying om m�Vact Fee Simple ownels riame
where mnVact is remided
Township
of daiman� (last �rve
�rivefs fernse / Iden�flcation / Othe
ol daimant's spouse (las! (rve dgiGS)
'�imp� _��/� L ald�Qp{, ^�y Ils
� Mo1 Z/ v
portim of Ihe revdential swcWre or Ne IarW nol exceeding one (1) arne �hat immediatety surtoui
Oroperty uo�¢eE m produce inmme.
Caunry
rownsni0
I hereby certity the above statemenis are We, mrtect and mmplete.
'Pddress(numbe� stieet,riry.;Wt entlLPcade)
K!
•' •
land not exceeding t(one) acre immediatery (� �
sunoundin residential im rovements.
ONerland (2)
Total land (line 1 plus line t) (3)
Dwelling (4)
Residential improvements or Mnualty
Assrssed Mobile / Manufactured Home Ga2ge (5)
Other improvemenb �6)
7ofal improvements (line a throug� line � (7)
7otal value (llne 3 pl�s line 7) (8)
I hereby certify tlie above is true, cortect, Sigrianua of,
and complete.
Vaifvinq acUOn - Signawre o1 Pyditw
Caunry
Issuin9 State
Remrd num6er � Page
al praperty U NmuaAy assessed rtrobile home (IC &7.7-;
sWmre is used N produce incane. desm6a the use and portion
20 _ pay 20 Lesser of 60% ot �he assessed value of Ihe homestead or 545,000
AbNnNSteM'ug eny olher proNSion, Iha svm o7the deducfiw�s prohded in IC 6-7.1-72 fo a rtabde frome tha( is 5
not assesse0 es raal property a to a menNarlured hcrrie thef 's rot assessed as real pmparry may nat exreed
Da:e signed (month. tlay. ST,arJ
Date signetl