HomeMy WebLinkAboutHomestead_TeetersCLAIM FOR HOMESTEAD PROPERTY TAX
.__ � STANDARD/SUPPLEMENTALDEDUCTION
State Form 5473 (Rt3l 12-09)
` Prescribed by ihe Department of Local Gwemment Finarce
INSTRUCTlONS: See /everse side for filing insWcLOns.
I(VJe) [�YT\MV2� �LSCIrIl�n (L_� �o io i A
place of residence or am (are) buyirg the fdlovring desaibed real property fw whifh a Homestead Pro
-der ntrad on ihe date ihis applintion is filed, (date of filing). I(We):
Own ❑ Am (are) buying under recordad contract
❑ Am (are) entltled to occupy as a tenent-stockholder of a cooperative housing corporation
❑ Have a 6eneficial interest in the Wst or Ihe right to occupy ihe property under ihe tertns of a qualified
❑ Am (are) the shareholder, partner or member of Ne entity that owns ihe property.
Name N daimant (/egal name)
Nama
Orivefs fxense / IEenUfiCdt
of daimant (lesl fi�e digitc)
numhar ot daunanPs spause (lau five tl"g#s) orivels licaissa / IaenntimWn / w�t
of daimanYs spouae (lastlne dgits)
If buying on conirecC Fee Simple
Recorders of6m where contreG is
Courrty
�lo �I�-�')
u ariv a�on or Ne res
of Ihe proparty utiIWC I
�
County
twne
(tlry. [own, rownshlP)
FORM
HC10
�
�
�°°°��� y (our) prinapal
n i ereby daimed
MAY 7 2012
rsonal residence Wst
IssWrg State
Remrd number
0
-�G b�� f.�%S I u�i � U�w,uauv a�s�e �noa n�e cic s-,.,.n
sWCture or the WM no� ezceeding one (1) acre that immediatey surrounds that sw<YUre is used W proCuce income, describa the use aM pwtim
ire Incoma.
Township
I hereby certify the ebove statemenis are We, correct and complete.
�
Land not exceeding t(orn) aere 4nmedtatey
surtounding residentlal Imp�ovements.
Othar lantl
Total land (line 1 plus llne 1)
Dwalling
Garoge
Other improvemenb
Total improvemeMS (Itrre 1 Nrough line 6j
Total value (Ilne 3 pl`s Ilne 7)
I hereby ceNfy the above is We, cortect,
and wmplete.
Vainvg acfim - Si9naWre of Auditw
i�)
(2)
(3)
(4)
(5)
(6)
�)
(8)
SignaLUe of Assessor
camry
• i
20 _ pay 20 _ Lesser of 60% of the assessed value oi Ne homestead or $45,000
IJofwiRUtand4g enYWherprovision, fha sum o/ Me deducfbrrs provitletl in IC 6f.7-72 ro e rrob,7e Mme Ne( is
not essesmtl es real property or ro e menWactured honie Nat is not es.mssed as real propeny may nW erceed
Mo-hntl /1/11 dMe umssed ralue o/Na RqW78 fqrtre ormen'decLlred homa.
S
Townstdp
Date sig�d (monN, daY•Ye�A
Date signM (monN, daY. Y�A
Da[e signed (month, day,