HomeMy WebLinkAboutHomestead_Young (16)�'"'^a CLAIM FOR HOMESTEAD PROPERTY TAX
_ ? STANDARD/SUPPLEMENTAL DEDUCTION
Sfdte Fofm 5473 (R72 / 609)
,�' � PrescAbed by Ihe Depatlmeni of Lo�l Govemment F(ance
INSTRUCTIONS: See reverse side lor filrng inst/uc(ions. (:l'' � C: / 7�, ��� �(a
�O
� YEAR� �
FORM
AU��lo4 20 9
�
I(We) Li ti" cerlify ihat I(we) occupied as my (our) prindpal
place of residence or am re) buying the following described real property to ich a Ho stead Property Tax Standard Oedudion is hereby daimed
under mnVact on the date Nis applicafion is filed, (date o/ ing):
❑ I(VJe) own ❑ Am (are) buying under recorded mnVact
❑ Am (are) entitled to occupy as a tenant-stockholder of a woperative housing wrporetion
� Have a benefidal interest in �he Wst or the right to occupy ihe property under the tertns of a qualified personal residence Wst
N a of daimant (kgal name) �_(/ � �
/._�/
Sodal Seanrty nm�6er da'unanl (bsf � )
a.
Social Sewriry numbrrof tlaimant's spausa (I five dg'rts)
tt buying on contrac4 Fee 5mple wmeYS reme
Remrdefs ofice where mntracl is remrdeC
Counry
TownsNp
(lazt frve d'gimJ
/
°
Issui�g Slate ` )
LN
Issuing State� 1
�� J
RetorO number Paqe
Pafcel number L al deuriplion p �7 Is Ihe property in question:
� N /I, � 6 " �{ ' �Q • �a.3 �{� �Real ProPeM ❑ ���aDY assessetl rtn6ile home (IC 61. i-7)
If any portbn of Ihe resi0enllal swcWre or Ne WM not azceedifg me (7 ) arre Nat Immediatety surtountls Nat swcWre is used to protluca Incane, dascnbe lhe use eM ponion
lof Ne P�PenY ���Taed to P�oduce inmme.
��-ia - i�- ioa. -�oi. 33�- o a.�
County
Township
1 hereby certify the above siatements are we, correct arM comptete.
i(num�and street, cily, sfdfe, aM
't Yra.�-�_
Land not ezceeding 1(one) acre immediauty
surrounding residential improvements.
Otherland
Total land (line 1 plus line �
Residentlal improvementa or Mnualty �Iling
0.uessed Mohile 1 ManWactured Home Garage
Other improvements
Totai improvemenb (line a through line �
ToUI value (line 3 plls Ilna �
I hereby certify ihe above is true, conect,
and complete.
/aityin� atlion - Signature of P�dtw
Counry
of
����? o
��)
(2)
(3)
(4)
(5)
(6)
�)
(8)
sivnawre ot nssessor
20 _ pay 20 _ Leuer of 60°h of the assessed value of Ihe homestead or 545,000
No7wilASfaM4g eny otha� piovivon, Na sum W Ne deductians provided in IC 6-f. f-17 ta a mobde home Ma1 ic
mt asseued as real property w lo e menulurtured home fhat a mt assessed as leal properry mey rrot esceed
.,��.han i�rn Nrnn acw_�cM value ot the mobile �ome wmenutaUUred hwne.
3
Townsh�p
Date
(monm. dar, r�
SignaWre W Autlitnr
. // `s/ I Date signed (monih. tlaY. Yea�)