HomeMy WebLinkAboutHomestead_FlamionCLAIM FOR HOMESTEAD PROPERTY TAX Fow�n �
STANDARD / SUPPLEMENTAL DEDUCTION HC�o
` � Sfate Fortn 5773 (R73112-09)
�„w PresrnLeA by Na DepartrneM of Lonl GwemmeM Finarxe
INSTRUCTIONS: See ieverse slde (or filing insWctions.
. .
�(yye� � certiry th I s o prindpal
place of residence or am ) buying the following described real property for which a Homestead Pfoperty Tax tand�d�ed�l re daimed
uMer mntraG on the date this appliralion is filed, (date olfiling). I(We):
❑ o„,� ❑ Am (are) buyiry under recorded contract 0 C T 2 2012
� Am (are) entilled ro occupy as e tenanFStockholder of a cooperafive housing wrporadon
n, ,-a-
❑ Have e benefidal interest in the Wst or the right to occupy the property under Ihe tertns of a qualified personaFre�ncetr�sty •
❑ Am (are) the sharehotder, partner or mem6er of the entlty ihat owns ihe property. V��
•' • •
Name N daiment (legal name) � -
se cle�ie� �a,r�e>
sod� sen,�ry ou� ur aam�a�rs soWSe (wst s� c,yas) onNers rce� � idenaru�ua, i wwl o�mba� issw�q siare
of da4nant's spouse (last !rve digds)
• �-� �
If buy'ug on convacL Fee Simple ownets twne
Remrdels oRxa wlwse con�ert is �emrded RecaN rwmEer Page
..�. . �
�� TaanshiP T' dis (�l: trnm� toimsh"ry)
Paicel number Legal tlewiplion Is the property in question:
11e� l�� 9 �f �T ❑ �i,�m ❑ ,�� �� �a ���� �-�.,-n
If arry pation of the 2sdentlal structure or Ihe land rat ex�eetling ona (1) aae Uut immatliatety surtwnds iha[ SWrture is used to produce'vimme, tlesrnbe fhe use arvl pation
W Ihe P�PanY utillzed lo D��m Inmme.
2-6 —�a-o� -id�- oo �. ��a_o �.�
-.� . . _ . .
Counb Tovmship Camh TownsNp
I hereby cer6fy Ne above statemenLS are We, corted and complete. Signa dalmant
PdA�ess number eM sfroet, fsty, state, aM LP a)
�i nJ. P � P �'7��
.- .
. . ., . .
„..
land not exceeding t �orn) acre Immedlatey ��� �.�,.�� �.��ttiK s i,�"'� s;Y,��
surtoundin residentlallm rovements.
�e v' .,.>�.t -�
Other lantl (2) .,�, t ; _� ,-,,,a.�,; _
Total land (lirre 7 pl�s Ilire S) (3)
-�. `2 � b'�� 'P 1 +%n�Mk'- �
ResideMlallmprovemen�orMnuafly �IIin9 (4) •:.r"`'� �g-x?s"Orar ..�*
AssessedMobOe/ManufacturedHome ��9e �5) _�s��.���i:"�_F � �.«+ �
Other Improvemenis (6) �"^ � ��3""� �a� '� - �
Total improwmeMS (Orre / Mrough fine � (7)
rora� vawe ���ne s Wus nna 7� (9)
I hereby eerdfy the abave is We, correct, �9^awra of Auessor Date sig�d (monm. deY.1��
and compleM.
Vaify'ug adbn - SignaCire MPUtlitor
Dam signed (rtanth. daY. Y��
� . • � � � • •
20 _ pay 20 _ Lesser of 60% of the assessed value of the homesteaC or $45,000
I�bMiMStand6g any otherprovisbn. Na sum o/Ne tleductiorts provMed in IC 6f.1-12 m e nab�7e Mme that is $
not assessed es real poperty a ro e menulactured home Nat is not essessed as reel pioperty mey nof exceetl
one-nei� �rz) aere essassea Vsn�e a�ne �,�ow�e rbme w ma�,eaca„m n«,re.
syran� orn„a;� oa� siynea �monm, eer. re�
e.