HomeMy WebLinkAboutHomestead_Craney0 yw 0 CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD / SUPPLEMENTAL DEDUCTION
State Forth 5473 (R13 / 12-09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for 66ng instructions.
FORM YEAR
nR1rL
1t
r
h
I (we) certify that 1 (we as my (our) principal
place of residence or am (are) buying the following descri real property for which a Homestead Property TaICS and u ' is hereby claimed
(date of filing). I (We): pUDttOtc
�e�ntract on the date this appl� t%nm'(are�
buying under recorded contract G18SON GOON,(,(
❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am (are) the shareholder, partner or member of the entity that owns the property.
Name of dalmant (legal name) ,
Social
CC///JC/
Name of claimant's spouse (legal name)
Social Security number of claimants spouse (last five digits) Odvels license / Identification / Other number Issuing state
of claemurmts spare (last five d0b)
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
County Township Taring (city, town, t ip)
Panel number
L�ag7 desai
Is the property in question:
/p[ion
I property ❑ AnmmaM assessed mobile home QC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediatey surrounds that structure is used to produce Income. describe the use and portion
of the property ufiilied to produce income.
.• .:
County Township County Township
1 hereby certify the above statements are true, correct and complete.
Signs =
Address (number and street city: state, and ZIP code)
`13zo s. 85�J
rr•,
(1)
r—
Land not exceeding lone) acre Immediately
surroundin residential Improvements.
.,
-'
Other land
2
O
Total land (line t plus Ilne 2)
(3)
su
Residential improvements or Annually
Dwelling
(4)
p'x- rrr, r •c ->
Garnige
Assessed Moons I Manufactured Home
()
34
Other Improvements
(8)
z
Total improvements (line 4 through line 6)
(T )
Total value (line 3 plus fine 7)
(8)
1 hereby certify the above Is true, corract,
Signatue of Assessor
Date signed (month. cloy. year)
and complete.
Veiylg arxian - Signature of Wmditw Date signed (month, day, year)
20 pay 20 Lasser of 80% of the assessed value of the homestead or $45,000
Noh iNSUndfng any otherpmvison, the sum of the deductions provided in IC 61.1 -12 to a rnobde home that is $
not assessed as rear propenyor to a manufactured home that is not assessed as real Property may not exceed -
rne -hall 12) of the assessed value of the mWe home ormanu actured home.
Signature of
Date signed (month, day, year)
I
1t
r
h