HomeMy WebLinkAboutHomestead_BoyerCLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTAL DEDUCTION
i 9 State Form 5473 (R12 / 6-09)
�� / Presaibed by Ihe DepartmeM ol Laml GovemmeM Frmrce
lNSTRUCTIONS: See raverse Side lorfiling inshucfions.
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DEC 1 9 2012
I (VJe) � certify tha�ll��c�i �;r�yf(���pal
place�of residen r am ( re) bu the following described real property for which a Homestead Property 7ax Standard Deduclion is hereby daimed
under mnVaG on ihe date this applicalion is filed, (date offiling):
�I(We) own ❑ Am (are) buying under recorded contract .
Am (are) enLUed to occupy as a tenant-stockholder of a cooperetive housing corpo2tion
� Have a beneficial interest in the wst or the right to occupy the properry under the tertns af a qualified personal residence Wst
sP�e (las( flve
tl buymg om m�traq, Fre $imple awnefs �ame
Counry
Tovmship
01 daimanl (lasf five d'g25)
Drivers ficense / Identifiration / ONer number
of daima�rt's spouse (Wst five d52c1 .
Pa�cel number Legal tlesaipUOn Is
��,-�-1-3a-3h3=1 o-3a�-anl �
If any portion af tha razldenUal SWCWre or Na WM not e:ceedinp ona (1) arre ihal immeEiatey sUrtow
of t�e pmperty unTaetl to produce incortre. .
To.mship
I hereby certify ihe above statements are We, correct and complete.
�
Land nat ezceetling 1(one) acre Immediately
Otherland
Total land (line 1 plus line 1)
ResidenUal improvements or Mnually �����9
Assessed Mohik I Manufactured Home Garege
Other improvemems
Total improvemen� (line 1 Nroug� Ilne �
Total value (line 3 plis line 7)
I hereby certify the above is true, cortect,
and complete.
Veifyitg ac6on - Sign2Nre of Pt�Giw
i+)
c2�
(3)
(4)
(5)
(6)
(%)
i8)
slgnaNre oi Assessar
Counry
IIsvimg Stata
Remrd number Page
town. township) �
E9��
�P�Y in Oueslion: '
eal properiy ❑ Mnua�y assessetl moWle home (IC 61.1-:
it 6WClu�e i5 u58E tO pN0uC8 inoome. desCnbB the usa and parGOn
. � TownsAip
2D pay 20 _ Lesser of 60% ot Ne assessed value of 1he homestead or 545,000
NolwilhstaM'ug any ofiei provision. Ne sum o/(hs detl�cL'ons piovided in IC 6-7.7-f7 b a moM7a frome that is $
not assessed as Bal property w to e rrenulaWred hwrn fhet is raf esseuetl es reel property rtray nof exr�ed
aneJ�aH (7/I) d fhe assestetl velue dNe moD'da home w manuFdCUred frome. '
SignaWreotNMitw � j ��
C.. T "1 � 1 ���L.2�c.�
�A
Date signed (monN, day, yea�
Date signed (mmN, daY• Y��
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