Homestead_Watson^ CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD If SUPPLEMENTAL DEDUCTION
State Form 5473 (R12 /6-09)
•S ,�� Prescribed by the Department of Loral Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
AUG 0 4 2009
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CERTIFICATION STATEMENT
I (Ilya) cer[tty� l�DaaM1n�d a!O% QA principal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under cl on the date this application is filed, (date of filing):
I (We) own ❑ Am (are) buying under recorded contract
❑ Am (are) entitted 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
INFORMATION.
N of da a (legal nam q p
IWI `•O
Social Security rumba d nt (last rive dgts)
ririvver's license
If buying on contract, Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
c -
Townsh Taxag district (city, town, township)
V
Parcel m r
•d Qp ppI) •
al 11-0-
6
Is the pm y in question:
eat property ❑ Annually assessed mobile tome (IC 61.1 -1)
0 any portion of the residential stmmre or the Land not exceeding one (1) acre that immediately surrounds that strumre is used W produce income, describe the use and portion
of the property uoTaed to produce income. /'�' ^ _ r� -A • ,A
OIC
jPROPERTY
OW CLAIMANT IN OTHER COUNTIES
County Township County Towns hp
I hereby certify the above statements are true, correct and complete.
Signature of aai t '
Address (number and street, city, state, and LP cod ) I ti O
r • r
• ' • r r' •
Land not a :seeding t (one) acre immediately
surroundin residential im rovements.
Other land
(2)
'= "i" "-?'
Total land (line 1 plus line 2)
(3)
Residential improvements or Annually
Assessed Mobile I Manu(acturetl Home
Dwelling
(4)
&� isn�"x's� +:
Garage
(5)
d� r.7Yrn?0&$.•.'r_
Other improvements
(6)
""' `•:�e_i'nA. .
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auden Data signed (month, day, year)
®
STANDARD DEDUCTION
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Nolwilhslandirg any otherprovlsion, the sum of the deductions provided in IC 61.1 -12 to a mobhe home that is 5
rot assessed as real property n to a nonufactured home that is not assessed as real pmperfy may cot eneed
onefiaH(12) of the assessed value of the mobile home or manufactured home.
SigroWre itn
Or– ed (npnth, der .year)
4-�
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