HomeMy WebLinkAboutHomestead_HornbyCLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD If SUPPLEMENTAL DEDUCTION
State Forth 5473 (R13112 -09)
„w Prescribed by the Department of Local Govemmem Finance
INSTRUCTIONS: See reverse side for filing Instructions.
ORM
uEC 19 201 Hc,o
C.
I (We) certify that I (we) occupied as my (our) principal
place of residence or am (are) buying the following desI real property for which a Homestead Property Tax Standard Deduction is hereby claimed
contract on the date this application is filed, (date of filing). I (WI
t'er
Own ❑ Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as a tenant- stockholder of a cooperative housing corpomfion
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am (are) the shareholder, partner or member of the entity that owns the property.
Name of claimant (legal name)
Social Security number of claimant (AW fne dub)
Ws icnse, /Identification / Other
3
of T
Name of claimant's spouse (legal name)
Social Seemly number of claimants spouse (last five digits) Drivers Irene I IdenUfication I Other number Issung State
of claimant's spouse (last Irve digits)
If buying on contract, Fee Simple owners name
Recorders office Where contract is recorded Record number Page
•. .
County Township Taring district (city, town, township)
Parcel number
IIIegaidescniption
Is the property in question:
❑ Real pmperty ❑ Annually assessed mobile home (IC &I.1 -7)
of�re residential sanctum the land not exceeding one (1) ace that Immediately surrounds that structure is used to produce Income, describe the use aM potion
IIf
N produce
3 _0� - 103_000 6IW 5 -00 9
.• . . • OWN
County Township County Township
77
I hereby certify the above statements are true, correct and complete.
Sig of claimant
Address (number and sheet, city state, and ZIP code)
y1 132R0C Ey �tlJ7
r
rr ..
Land not exceeding 1 I acre Immediatey
(1)
surrounding residential lm rovements.
Other land
(2)
♦ g-�o
Total land (line f plus line 2)
(3)
Dwaliing
(4)
e
Residential Improvemnts or Annually
Assessed Mobne / Manufactured Home
Garage
5
F r h�`s:;SY itr i Si
_
r0
Other improvements
(8)
air s V.
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 here by certify the above is true, correct,
St of Assessor
��
Date signed �
(N' day, )61
and complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
14 P-1 .. • . . .
20 pay 20 Lesser of 80% of the assessed value of the homestead or $45,000
Nafwilhstandng any other pmvision, the sum of the deductions provided in IC Gf. 1-12 to a mobile home Nat is
$
not assessed as rent property or to a manufactured home that is not assessed as real property my not exceed
one -haH 112) of the assessed value of the mobile Mme or manufactured home.
Signature of Auditor
Date signed (month, day, year)
C- T