HomeMy WebLinkAboutHomestead_Smith (49)CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
- State Fwm 5473 (R73 / 12-09)
` � Presaibed by the Department of Local Gwemment Finance
Fo� � I �
HC10
INSTRUCTfONS:Seereversesfde%rfilinginshuclions. APR 5 Z��2
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1(We) `"� . ��.J certiry that I(we) occupied as my (our) p�d�
place of r e or a are) buying the fWlowing described real property for which a Homesiead Property Tax Siandard D��s��r��y�i ime�f.�T R
9UDI
�er co ct on the date this appliption is filed, (date o(filing). I(We):
Own ❑ Am (are) buying under recorded conVect
Am (are) enlitled to occupy as a tenanbstockholder oT a cooperaUve housing corporation
❑ Have e benefidal interest in ihe Wst or the right to occupy ihe property under ihe tertns ot a qualified personal residence Wst .
❑ Am (are) the shareholder, partner or mem6er oi the enlity that owns the property.
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Nameotd � nt name)
Sodal ry of m(gst _d+9�) of daimanhcense /� ���lon / ON� �� Issuing Slate
Sodal Securiry numEer
/
.,- . .-. .
If buying on concraU, Fee Sirnpla owners name
Recorders of6ce where contreti is recorded Record nurtibei Pape
..e. . � . �
counry 7a.mship T (ryy: row,,. ro,msn;a)
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Pa�cel number � �P�n Is Ne in question:
-�-�(� Real poperty � AnnuaOY essess�W moWe home (IC 6-7.1-7)
If arry portion of the fcvdendal sWCtura a 1he IafM not exceeding one (1) acre Uu� immetliately �� cWre is used m produce income, desaibe the use arvl portion
w me o�cem �w�a ��oa,ce mc�e. ,
��lo -�o?-O% /a�- DQ/. /.3�-6a��
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Caunty Taw�sship Counry TamshiP
I hereby certify ihe above statements are We, correct and complete. SignaNre of tla t
nea,���,e„e��.�'r� S�'�r�-`-�:� � ��Cz��
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Land not ezceeding 1(orre) acre immedlately .� i s ,�'"4.. -;:'� t ��; `�'
surroundi resldential im mvements. ��) �'��??' ��'`'�`' .._ ^'� '~-r''°i°�
s_ }` •G:�,Yt -G
Other land (2) �,� ��`: �.�=
rora� �and (�irre 1 plus �irre 2) � (3)
Dwellin9 �4) at.�'"�r�.*.,•�c���',r�--�"r
Resideirtial improvemenu or Annuaiy � . .
Asseased bloblle 1 ManufacL�red Home Ga�9e �5� t.�� ��y� ��� �¢��,� i�,-�,'=
*' �;s'� �.{: ' � - - '
Otherimprovements (6) s � �;-
Total improvemeMs tline 1 Nrough line 6) (7)
rmai �aW. �r,ne � pr/s mre n (s)
I hereby certify the above is We, wrtect, �9"a� of Assessor Date signed (monm. tlay, yea�
and complete.
Veilying action - SS�Nre of MWitor Date signed (rtqnfh. daY. Y��
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20 _ pay 20 Lesser of 60% of the essessed value oi the homestead or $45,000
Nolwilhstanding any oNerpravis,on. Ne sum o/Me deductims provkled in /C 6/.7-/2 ro e rmW7e harre Mat is $
rat essessed es iea� a�aem w ro e menNaaured �ame mer is na essessed as reer v�veM rnay mr exceee �
one-haM(f21 dNe essessed value o7fhe rt�oWe hwne or manidaGUred home.
SigtaWre ofluditor Date signed (month. daY. Yea�