HomeMy WebLinkAboutHomestead_StilesCLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD I SUPPLEMENTAL DEDUCTION
6 � State Form 5473 (R121609) 0
Prescribed by the Department of Loral Government Finance .
APR 19 2012
INSTRUCTIONS: See reverse side for filing instrtrU)ons. '
CERTIFICATION STATEMENT
I(We) QQ 77t-2Tz certify thalilbS
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduc on i Sy1feTLtl�T Ated
contract on the date this application is filed, (date of filing): -
�under
DCI I (We) own ❑ Am (are) buying under recorded oontract
Lr�J, 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
INFORMATION
Name of claimant (legal '
l�
Social Seaxrty mnmter mt (6 dgts)
river's license I
Name of dauram'
Social Searity number of daimam's spouse (last hire digits) Driver's license I Identification I Other number - Issuing State
of claimant's spouse (last five digits)
CONTRACT •-r r
If buying on contract, Fee Simple awnefs name
Recerdees office where contract is recorded Record number Page
PROPERTY r
Township
T datrict (city, to township)
x \
Pa number
Leg description•
Is the property in ton:
'
7
❑Real property _ ❑ AnnuaOy assessed motile tons (IC 67.1 -7)
Aof
g any por on of the residential structure n the rid not exceeding one (1) ate that Immediately surrounds that structure is used to produce Income, describe the use and portion
the property &9
�O/ 000.
PROPERTY OWNED BY
County Township - County Township
I hereby certify the above statements are true, correct and complete.
Sighature of
dress (number and street dtK state, and ZIPcode)
S s 3qo o TN 97611
e N
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD NON-RESIDENTIA
AT100%OFTTV I VALUE VALUE
Land not exceeding 1 (one) acre Immediately ` m
surrounding residential Improvements.
Otherland
(2)'
Total land (line 1 plus line 2)
(3) '
Dwelling
Annually
(4)
�eJfYY Y.x(i�a.Y- . {c1i.
Assessed Model Manufactured tr
Assessed Mobile I Manufactured Home
Garage
„ k°
3° a
Other Improvements
(6),'ycN,
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(B)
1 hereby certify the above is true, correct,
Sigratule of Assessor
Data signed (month, day, year)
and complete.
Verifying action - Signature of Auditor Date signed (nonth, day, year)
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000 - -
Nofwiautandng any otherpmvi . the sun of the deductions provided in IC 61.1-12 to a mob7e lame that is $
not assessed as reel property or to a manufactued home that is not assessed as real property may not exceed -
one4wff (12) of the assessed valve of ao mobile home ormnufadured home.
Signature of Auditor
Date signed (month, day, year)