HomeMy WebLinkAboutHomestead_Seifers (4)CLAIM FOR HOMESTEAD PROPERTY TAX
__ STANDARD / SUPPLEMENTAL DEDUCTION
. . State Form 5473 (R73 / 12-09)
� � Presaibed Cy the Depanmant of Lacal Govemment Finance
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INS7RUCTYONS: See reverse slde /or fiGng inshuUions.
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�(yyeJ ' rtify that I(we) ed as my (our) prindpal
place of residence or (are) buyirg ihe fdlowing described real property for whid� a Home ad Property Ta�c Standard�����(\by daimed
under contred on the date this applintion is filed, (date of filing). I(VJe): v-�
G�BSON COUNTY q�p �pR
� Own ❑ Am (are) buying under recorded contract
❑ Am (are) entilled to occupy as a tenant-stockholder of a cooperetive housing corporalion
❑ Have a benefidal interest in the Wsl or lhe right to occupy the properry under Ihe terms of a qualified personal residence trust .
❑ Am (ere) the sharehoider, partner or member of the entity ihat owns ihe property.
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Name of da4nanl(legel j �
s�odel smnily (
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Sodal Seamly nurt�r,of CamwH's spousa (last (� dlglLS) Drivers Ikertse 11denUflcation I
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If buying on conflaU, Fee Simple ownefs (wne
Recordefs offica where contraa is recarded Remrd number Page
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Counry Townsnip Taring dishirt , t . lownsh� )
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P number Legal deSViPtion Is the property in Ouestion:
�(o-O (�I -O b-3oD-cX�. d o- 1 � w�n ❑,w,�nr es�a �ua n� uc a�,.,-n
It airy portion ol Ma residenUal sWcture or the IarM not exceeding ane (1) aae Net immed"ately wrtoun lhat struCUie is used to produce inmma, Oescnbe Ihe use arvl portbn
oi Iha property utilRed ta produce inmma.
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Counb Tovmship County TownsNp
1 hereby certify the above statemenLS are we, correct and complete. S or da' an� 1
�InC l r eM sveet� d(Y•`ate. ardW� �� ��ZI 2�� 1.1 �/�+ � 7 'v
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Lend not eaceeding t(orre� aere Immediatey �» ���'`�� � K�� r,,s � x3' �,
surtound)n resldential Im rovements. - -
e c ,�,y.r.��_l}3�...
Otherlantl (2) � .. ,�;�`�'.r3s�_
Total land (Itne 1 plus flrre 2) (3)
DweI11n8 (4) -� c� �� '_`''�i� 2�y`�rY
ResitlenUallmprovemenfsorMnualty _ � �
Asaessed Mobile I Manufaetured Home ��9a 5 -�.-..� f'„ -#$32� � 3� �'�-:v..�_
� ) .,.�.. c�.v.—.. `;i.�_:... -
"::,�.?y:..;�;: y�p±.r-�:
Otherimprovements (6) i�� ::=�+�x'-�'s.%.-'�'�'�-.''".
Totel improvameMS (Iine / fhro�gh line � (7)
Total value (Ilne 3 pl/s Ilne 7) (8)
I hereby eertity the abova Is trve, eorrect, �9^awre of Assessor Da�e a9ned (rtron(1�• daY. Y�A
and wmplete.
Veitying aabn - 35�wre of Audimr Date si9ned (rtanN. daY. Y�)
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20 _ pay 20 _ Lesser of 60% of the assessed value ot the homestead or 545,000
NofwithsfeMing eny oflrerprovision, tha sum o/Ne deductrons provided ln IC &1.1-72 fo e rtpW7e home Nsf is $
nof asvessad as real property w ro e menu/a�Ywed home fhet is not assessed as 2al pioperty maY raf exceed
one-r, irzl dure essessed rah,e aMe mowm nane ormenulecLnednome.
of i Date signed (montA day,pgls�
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