Homestead_BolingCLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD if SUPPLEMENTAL DEDUCTION
�r State Form 5473 (R1216-09)
'1 ! Prescribed by the Department of Loral Government Finance
INSTRUCTIONS: See reverse side for fling instructions.
FORM YEAR
HC10
F II.
I (We) c,4" t4— D certify that I (we) occupied as my (our) principal
place of residence or am (are) buying the follow4 described real pmp or which a Homestead Pmperty Tax Standard hj by claimed
,.fQedu�ccttlior�r
contract on the date this application is filed, (date of riling): ' (
�O(70K
,under
" COUNTY
M I (We) own ❑ Am (are) buying under recorded contract
GIBSON
Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
1 1. CLAIMANT'S INFORMATION
Name of dai nt ( alpame)
Social Security number
Name of of d
' ht's spouse (legal name)
Sodal Seamy num_w b olff dda nt's spouse (last five digits) Drivers license I Identification
•
If buying on mntra0. Fee Simple ownefs name
Recorders office where contract is recorded
Record number Page
PROPERTY DESCRIPTION,
Coway,
Township
T dsidd (city, own, township]
nn CC ,,�r��
116 S V "/
Panel number
L ption /y�'
G— )—
Is th property in guestio
/
Real property Annually assessed mobile home (IC 6-1.1 -7)
any i of the residential structure w the land not exceeding one (1) acre that immediately sumunds that structure is used to produce Income, describe the use and portion
®If
of me rly uplized to produce income.
UG - / 60 - - D I ?7
00 17
PROPERTY OWNED BY
County' Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
Address (numberand street. dry, state, and ZIPcode)
• • . • r USE ONLY
ASSESSOR TRUETAXVALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
2
;sue- ?;"- ;.'if"'fi=
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Garage
(5)
Assessed Mobile I Manufactured Home
Other improvements
(6)
G•r - '"s:9'rt
0.3 (. ifii...f. r"'f•=
Total Improvements (line d through line d)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (mouth, day, year)
and complete.
Verifying action - Signature of Auditor Data signed (month, day, year)
STANDARD DEDUCTIONALLOWANCE
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Nolwimstandag any ofherpmvision, the sum of the deductions provided in IC &l.1-12 to a mobile home that is $
not assessed as real property a m e manufactured home marts not assessed as reel property may rot exceed
onehafl (12) of me assessed value of the mobie home or manufactured home.
Signature of Auditor
Date signed (month, day, year)