HomeMy WebLinkAboutHomestead_Ewin (2)"'^ CLAIM FOR HOMESTEAD PROPERTY TAX
. STANDARD/SUPPLEMENTAL DEDUCTION
S`Y Sta:e Porm 5473 (R12 / 609)
' s arescrited M wa �vartmem ot �om� co�rermrem Frer�ce
INSTRUCTlONS: See raverse side /or filirg inshuUions.
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�AN 16 2013
I(We) • certiry ihat I(we r) principal
place of residence o a (are) buying the following described,real property tor which a Homestead Properry Ta��� " a��' rd -
,,,u...���nd(((er mnVacl on the date this application is filed, (date o/ filing): �
�I (We) own ❑ Am (are) buying under recorded contraq
Am (are) en6lled to occupy as a tenant-stockholder ot a cooperetive housing corporaGon
Q Have a beneficial interest in ihe Wst or the right t� occupy ihe property under the terms hf a qualified personal residence wst
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Name of da' m(kgal name) � (' •
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C.� (.[. .
Sotlal
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Social Securiry num6er o( tlaimanfs spouse (last five tligvs) Orimrefs licensa / IdenGfiration / Other numbar Issuing Stale
of daimanfs spouse (lasl five digrLt) '
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If buying m mntract, Fee Simple owneYS nama �
RecorOers at(xp where mntrad is refnfded Reoo�d number Page
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� h � TwmshiP T' isbi (ci(y townshiD)
� O y
Pa umber 3 Legaldnsaip' �� peMymq�y��p�:
.=7 • � . Q7 �i aecenr . ❑ M rtua�e nane (ic �-,.,-n
If anY Portion of the 2sidential strumre or t7re IariC nol exreed4g me (1) aae Ihat immadiately surmu Ihat shucLire b used to P�� i�wna. Eesc�e the use aM portion
of Ne property uNaed to podum tr�mme.
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Cou�N TavmshiP Counry ' Townslup
I hereby cerliry ihe above statements are tnie, correa afM complete. s ture ot dai i �
Aress (number antl sfreet, dry, slate. and ZIP code) �� n '' ���� Q
a- W ! V- ! i c��'�f"/
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land not e:ceeding t(one) acre immediatey ' �'--��„£i, �,r.-����'�'',�t'�'rz �
surroundi residential im rovements. �» -�.°'`�����:$+f?.`3 `-..T�=� -..-�€�M1���.0
. . �r:;t,..,-rt,•
OtAer land (2) �-�'� tt't.y,���h,�.`.+
Total land (line 1 plvs line 1) (3)
ResidentiallmprovementsorMnually �Iling (q) . ttb���'„� s ��-#Y3x+3�M1 *r a�.�..
^� �`�v�,� .r+"+
Aurssed Mobik I Manufactured Home Garz e �� ��vC.�'���''w`` �K
9 i5) Lsn;r�' �.s�'.. kz.w <�..s`Sr`.;.°`� o-<.
�� ,,y;,;. s{
otherimprovemeirts (6) � :��i-',,.,�,��?a;�e��;•`�g
Toql improvemenls (line I through line 6j (7)
Tofal value (llne 9 pf`c line 7) (8)
I hereby certify ihe above is true, cortecl, Signature otASSesmr Date slgned (monM, day, yea�
and complete.
Vaifying action - SignaWre of ALdiw Date signed (rtronfA. day, yea�
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20 _ pay 20 Lesser of fi0% of the assessed value of the homwtead or $45,000
NotvAfASfarNirg any oNerpro�ivon, Ne sum olthe deductions prowdetl in IC 6/.1-72 to a rtrob➢e fame Nat k $
rrot asxeued es real property w to a manuFactured hwne Ihat is nof assessed es real property meY not exceetl � - -� —
onehaM (iQ) W(he assr.sced velue a/fhe moblle home or manufactured hwne.
S9nature o(AUS�tor . _ Data signed (monlh. daY. Y�)