HomeMy WebLinkAboutHomestead_Davis (4)""n CLAIM FOR HOMESTEAD PROPERTY TAX
�._ ? STANDARD/SUPPLEMENTALDEDUCTION
y State Fortn 5473 (R12 / 6-09)
' f Prestnbed by Ihe Department of Loml GovemmeM Friance
INSTRUCTIONS: See reverse side lor filitg instructions.
R YEAR
� C70 �
�
JAN 4 2013
I(VJe) – 1 � ceIrti tiiL�Pr �1 s my our) prindpal
place of residence or am (are) uying the follovnng described real propery for which a Homestead Pro A�CdrN e�c[IdR�l��by daimed
,u-�nd/ery6 nVact on ihe date lhis appliralion is filed, (date of filing):
�j I(N'e) own ❑ Am (are) buying under recorded conVac[
❑ Am (are) entitled to occupy as a tenanhstockholder of a coopereUve housing corporetion
� Have a benefidal interest in the trust or the nght to occupy the property under the terms of a qualified personal residence Wst .
Taring dsiria (rity, lown, townshipj
Record number � Page
number �•r�,,� Legal desaiptim . Is Ne property in queslion:
��G� U� .� ❑ Reai omvertr ❑ a,�uauv as��e �wie no� �ic �-�.i-n
�—.
�.�.y
portbn o� uie�la sWCwre w the IafW nol exceeding me (7 ) acre Nat immediatey surtountls ihat struau2 is used W produre inoome, Eescnbe Ihe use and partion
P�PeM u0f¢eE tu ProOUce inmme. .
Counry
Township
Couniy
I hereby certify the above sfatements a2 We, cortecl and mmplete. Signam7 of
_ '///�
Address (numbeiaqd¢treet. cily, state, andZlPcode) _ � � / .
Land not exceeding 1(one) acre immediatety .
surtoundin9 �idential improvements.
Otherland
Total land (line 1 plus line 2)
Rnidentlal impmvementa or Mnualty �����9
Assessed Mobile 1 Manufactumd Home Garage
O[her improvemeMs
Tofal improvemen6 (llne / through line 6�
Total value (line 3 pl,a line �
I hereby certify the above is We, cortect,
and complele. -
Vaifying acfion - Signatme of Audtw
(�)
(2)
(3)
(4)
(5)
��)
(8)
Signatura of Assessor
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
NoNnNStarMUg any dherpmvision, Ne sum of the dedurloru providcd in IC E1.1-12 ro a rtm6�1e home fhat 45
rnW essessed as 2a1 property w(o a manu7actuied hrnie Nat is rrot assessed es real propeily may not erceed
rviWuH/1?I Nfhe asscssed value NMe mo6i/e home orm3nutdCturetl/rome.
g
Township
Date signetl (monM, EaY. Y��)
Date signetl (rtronfi, day, yea�
day, yea�