HomeMy WebLinkAboutHomestead_DucharmeCLAIM FOR HOMESTEAD PROPERTY TAX ����� vEart
, STANDARD / SUPPLEMENTAL DEDUCTION FORM �
S S�teFo�,�,3cR,2,�> JAN 30 2013 Hc,o
�O � Presaibetl by Ne Departmenl of Laal Gavemrtrenl Fumrce ,
INSTRUCTIONS: See 2verse side forfiling instruc(ions.
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I(VJe) certify ihat I(vre) occupied as my (our) prindpal
place of resi ence or am (are buying the following described I property for which a Homestead Property Tax Standard Deduaion is hereby daimed
under coniract on Ne date this applica6on is filed, � (date o/filing):
�I(We) own ❑ Am (are) buying under recorded conNaG
Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation
� Have a benefidal interest in ihe Wst or the right to occupy the properry under the tertns of a qualified personal residence wst
•- • •
Neme of daimant (kgal name)
Saaal fne Gg,is) Drivers Ikense I Identificalion / Olher
e ot tlaiman['s spouse (legel imme) �
' I '
m daimarrt�::co�se (lay rrva d'q;csl
• ••� �
If Wyug m cantra4 Fre SimpM awnefs tame
Reoo�defs of6re where mnUad is remNed ' Remd numCU Pege
._�. _ � . �
County Tamshi0 Ta�mig d¢ 'p (ritY• lown iG)
PafcnJ number �egal tlesaiD�+ �s U�e in Questim:
' I pmperty ❑ Mnua�y assessM modle Mme (IC G7. f-�
If any poNm of Na residential strucNre or Ihe IaM not exceeE'ug me (1) aue that immediatety surtou ds that shuctne b used to pmduce'uroome, desm'De 1he use antl ponion
ur me woaam uwaca m w��e inmme.
al�-oa - 5 � - o3a -a� .a5a -o�
-.. . . : . .
Counry � � TovmshiD ' Counry Toan^.Np
1 hereby certify the above stetements are We, cortect and complete. �`"'"� �
Pddress (number antl sLeet, pry, sfa:e. aM LPmCe)
ai ma;,..s� 2/�,, u�e�c� .
, . ., . ,
�- � „ .
land not ezceeding 1(one) acre Immediatey �y`45"v'�'"."yo }°`l+i��'" �=
sunoundin residentlalim rovements. (�) � ���`��-a-�� "�`•��"�
#�� gt �� '
Other land � i2) ';:'�''se�'�:�.�..�="
Total land (line 1 plus line t� (3)
�„i �-" ;,c����"t��'�_�
ResldenUalimprovemenborMnually �Ilin9 (4) Lq_u{,�+�i�a.,�F3�c,��-,sqx,,,,_�
A.sessed Mobile I ManufacYUmd Home 8 .�.�5-'�i; ��'^x"-.�.��k'x-a���'^�:
Gara e (5) t:�rlFz a1e9'':' ¢'`.aiSA�s��".-
�9�n'� �
Other improvemenb (b) �a'��,a`,��
Total impmvements (line e thmugh Rne 6j (7)
roai �awe (Itne 3 pl�c Ilne � (e)
I hereby certify the above is true, wrtecl, SignaWre of Assessor � Date signed (manth, day, yva�
and complete.
Vaifyim� eclion - Sign3N2 of PLdtw Date 55�ed (month. d3Y• Ye�
�.-� � � � •
20 pay 20 _ Lesser of 60% of Ne assessed value aF the homestead or $45,W0
Notwi(hslaMirg eny otheiproNSion, Ne sum W the deQUClions proviCetl in IC 67.7-12 b a moW7e fpme lhat lc $
not essessed es resl popeM a�o e menNectured hwna Nat a rot essessad es real property meY nW exraed
orelieH(12f d Ne assassetl vafua d(he mo6de �ane or manufactured horta.
SigreWre ofPUdimr � Date signeC (rtronlh. tlaY• lea�
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