HomeMy WebLinkAboutHomestead_Johnson (2)"'" CLAIM FOR HOMESTEAD PROPERTY TAX
, STANDARD / SUPPLEMENTAL DEDUCTION
S v State Foem 5473 (R12 / 6-09)
�� I Prescribed Dy Ne Departmem of Local Govemmem France
iNSrnucnoNS: s� ���e � rorhr� rnsn,w�ans
���
//
f , _ i � r.�...:�
E 9 '4 `' �i�'
DEC 31 2012
.
I(We) � certiry ihat I(we�) orc^w�iNed7 avs pm�� uTrh1 pRrindpal
place of residence or am (are) buying ihe tollowing d real property for which a Homestead Property Ta��Aid'D�CUdioh i3h€reb�Tdaimed
�und r eonVaG on �he da[e Ihis appli lion is filed, (dale o/filing):
{(we) own (are) buying under recorded contract ,
❑ Am (are) entitled to occupy a a tenant-stockholder of a cooperaWe housing corporafion .
� Have a benefidal interest in the wst or Ne right to oxupy Ne pmperty under the tertns of a qualified personal residence Wst
.- • •
Name ot da' t(�� � Cy i//
!/ . d �
ifiA.<ly' —
Sodal �da'v�ant (last frve d'gE) Drivels licens IdentiHOtion / ONU number Issu'u�g Sate
/�/�� ofdaimafrt( lHedig2c) / �
Name of 's spouse (lepa/ nemeJ
Sodal Secunry
/
• ••� �
m crntracl, F Sim s na e • -
� o2� aoC � 0 8 i
Rem e s o76ce where cmtract u remrEeC ' Remd number Page
..�. . � . �
Counry / 7amshi7 Ta�G�g d¢bid (fi(J: town. townShi➢)
J�4 d.r�
ParrnJ rwmber �e9al tlesrtiDUOn Is e pm in question:
eal pmperty ❑ AnnuaOy assessed rtnb0e home (IC &7. f-7)
I( any rlion d Ne resdeniial strucNre a Itre WrM not e�trg ane (1) aoe Nat unmedately surtou i struc6na Is used b yoEUm Inmrta. Oescribe the use and portion
or m aem w�ea m�e� m�.
��-�� a7-/��-Gad. ��-�a/
-.• . ._ . .
Counry To.mShiP Caunry Townstdp
5' natutepl daimarn '
I hereby cerliy the above stetemenis are We, corteG and complete. / ��
!�i
Pddress (num6er and sttee4 rn1: sfate, and LPtade) ' - ' .
�s � 6 � —F-� 3
. . .� . �
�- � „..
tand not exceeding 1(one) acrc immediatey � ' �,� ���x-'�.�����`��".j,-,
surtoundin resitlential im rovemen�. ( � ->x F� a--� s�3+'- z
Yx" k
ONerland - (2) .'��.*i+„7,`;�`rr,,: �{ti:
Total land (line 1 plus line T) (3)
Dwellin9 (<) ��-''E � �i�� ��
ResldentlallmpmvementsorMnualty '°°'s'��-"�8 �`�'-- �'� ''�
lvssrssetl Mobik I ManufacWred Home Gare e ���`�'''�� F�n�����
9 (5) <•'_,t!%'','tafx�.'.�: �553.
5�;,, 4 ��k „. ,
Other Improvemerrts (6) ;'} �S?'„:�r?�� ,
Total improvemenb (//na 0 fhrough Ilne � n�
Total value (Ilne 3 plls line 7) (8)
I hereby certify the above is W e, corted, Sqnawra of Assessor Date signad (rtanfh. deY. Y��)
and complete.
vaayinq a�on - Sienawre oraq'itor - � oate sigoed (mmm. aar, r�d
� . - � � � • •
20 _ pay 20 _ Lesser of 60% of the assessed value of ihe homestead or $45,000
NoMdhstaMUg any oNerprovision, Ne sum d the dedtmA�ortc provitletl in IC 61.1-12 fo a mo6de fanre Net is $ � .
not essessed as real pvoperry w!o a rrenNzcfured home Net 6 not assestad as ieal popeM mey no1 exceeE -- -
one�haH(12f W Na assessed ralueW ihe mo6➢e hwrre wmanutdcturetl home.
SignaWre d PLtlitw Date si9ned (manfh. CaY. Y��)
GI