HomeMy WebLinkAboutHomestead_Tooley (3)S Y.' •� CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTALDEDUCTION
S Slate Form 5473 (R12 / 6-09)
�' � Presuibed by the Departmenl of Local Govemmenl Frafee
INSTRUCTIONS: See reverse side for filing ins(rucfions.
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MAY 2 4 'LO10
�(We) certiry 19���?) �CCitlRla as nMN�H'�nnapai
place of resi nce or a re) buying the tollowing de 'bed real property fw which a Homestead Properry Tax Siandard Dedudion is hereby daimed
under mnVact on Ne date this appliralion is filed, (date offiling):
�I(We) own ❑ Am (are) buyinq under recorded conNact
Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporatlon
� Have a beneficial interest.in �he Wst or the nght to occupy the O�Perty under Ihe terms of a quaiified pereonal residence Wst
Sa1M5eanlY
$orial Securiry number af tlaimant's spouse (lasl five di�
If buying am m�4scf, Fee Simple ownets �ame
RemNefs ofice where mntrad is remrtled
counry rownsniv
Pa¢elnumber L alde5
Sta;e
01 da'imant (Wst frve
Drivels license / Itlentificalion / Othet number
of daimant's spouse (Wst five di9its)
IRemd number I Page
•
(ia� (c�iry�, �rown�, tow�n�chip)
� �.lJi �-C'..SL.7L^M )
Is Ne property in Question:
I �`y�L1�n �l'1�1701. "F.�KLJ 1�"'�y � ��eal praperty U AnnuaM vssed rtro6ile home (IC 6f.1-71
portbn ot ine revdentlal swcwre or Na W�d not exceeding one (t) acre �hat imme0iatery surrou s ihat swaure is used �• aroAUro -e the use aM portion
PmPenY uo!¢ed to Produce income. .
a�-��-o�-�laa-cY��t� ��i�-6a�� . . -
Tawnship
�
I hereby certify the above statements are we, cortect and complete.
Pdtlress (number and sneet. ary, sfate, and ZIP code)
Land not e:ceeding 1(one) acre immetliatety
surtountling residential improvements.
Otherland
7ofai land (line 1 plus line 2)
Dwelling
Residential improvements or Mnually
Assessed Mobile I Manu(actured Home Garege
Other improvements
Total improvemenis (/ine 4 Nrough Ilne b)
Total value (Ilne 9 pl`s I(ne 7)
I hereby certify the above is true, cortecl,
and complete.
/eritymg a'rim - Signamre of Nidtur
(�)
�2)
(3)
(4)
(5)
(6)
(8)
o(ASSessor
County
Signawre of daimant
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or 545,000
NMui(hslaridvg any other pmvision, ihe sum ol the tleductidu p�oridetl in IC 6-7.1-72 W a mo6de Fame Nat is
rot assessed as real property w m a manNaUUred hwne 7iet is nat essessad es real pmpeM meY rot exceed
nnw-naM /f/11 N the a.ssesced rdlue ot Ne mobtie hama w manu/aUUretl home.
S
P
T�wrvship
signed (mwith, tlay, year)
Date s9ne0 (rtronN. tlaY, l��
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