HomeMy WebLinkAboutHomestead_Gray (2)CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD /SUPPLEMENTAL DEDUCTION
s• State Form 5473 (R1216-09)
'O •� Prescribed by the Department of Local Govemment France
INSTRUCTIONS., See reverse side for filing instructions.
FORM YEAR
F i_ HC
I (We) A iQ - certMat 1(we�){ occupied as my (our) principal
place of residence or am (are) buying th ollowing describ r I property for which a Homestead Property'Taz ft�r)d8l0 ction is hereby claimed
under contract on the date this application is filed, (date of filing): OIBSQN COUNTY AUDITOR
[:11 (We) own ❑ Am (are) buying under recorded contract
❑ 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
INFORMATION
Name of ai ( I ame
Social Security nub d Uamtanl (last dg. )
ers license
Social Security number of daimant's spouse (Iasi five digits) Drivers license I Identification I Other number Issuing State
of claimant's spouse (last five dgils)
'CONTRACT ••r .
If buying on comma, Fee Simple owners name
Recorders office where contract is recorded Retard number Page
PROPERTY DESCRIPTION
County
Township
Taxirg district (city, to ownship
P I nu {{yy//`'��
Legal description
Is a property in question:
'1. M.
1(00-007
1 property ❑ Annualty, 'le Mme (IC 61.1 -7)
any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce Income, describe the use and portion
®If
of Ne property utilized to produce income.
PROPERTY OWNED B
County Township County Township
I hereby certify the above statements are true, correct and complete.
' ature o ant
dress '(number and street, s :e, and ZIPcmde)
ASSESSOR USE rNLY I.TRUE TAY 'VALUE I ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements. S'' s5 _nx'j"..,.r17•;y..v_.s:.._<:u.i
Other land
2..'r,,;ay�`r+ri5
Total land (line 1 plus line 2)
(3)j,.
Dwelling
(4)
y,}.s.
_ 1 x'.c;�-3�'S i,- ^•c%rr
Residential Improvements ar Annually
Assessed Mobile I Manufactured Home
Garege
ra'iP ('ia�'w:`sy ;w'�r"�t'f'�`�
(5)
Other Improvements
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Data signed (month, day, year)
and complete.
Verifying argon - Signature of Auditor
Date signed (month, day, year)
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Abovid,siandirg any other provision, the sum of the deductions provided in IC 61.1 -12 fa a moDr7e home that is
S
not assessed as real property or to a manufactured home that is rat assessed as real property may not exceed
(1/2) of the asssjsV Vue of the mobile home or manufactured home.
relul
of Itor
Da ed (month, day. yeaA .