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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD /SUPPLEMENTAL DEDUCTION
State Form 5973 (R12/6-09)
/609) 1 I f
� Prescribed by the Department of Loral Government Finance p
INSTRUCTIONS., See reverse side for filing insirtxtions. L � A ' , n —/6
FILFOR YEAR
1
AUG 1 1 zuw
`_12y 11; ✓_
CEF •
I (VJe) OI8S0 ce That I v eU Ted as m
ndy ( ) p y (our) principal
place of residence or are) buying thi following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contras on the a this application is filed, (date of filing):
P'7 (We) own ❑ Am (are) buying under recorded contract
/❑ 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 dafmant (legal name)
fry
Name of datrnanrs spouse (legal name)
Sodal Seaxity number of daimant•s spouse (test five digts) Drivers bcense / Ida tfx tbn / Other number Issuing State
of claimant's spouse (last fire dgits)
CONTRACT ••s s
11 buying on contred, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Tamship
Tang d trice (C&, town. township)
Parcel number
L al rl(;fpiption the property in question:
`7 Q I property ❑ Annually assessed mobile home (IC 61.1 -7)
If any portion of the residential structure m the land not exceed one (1) aLlm that inviedlately surm6nds that strucwra is used to produce income, describe the use and portion
of the property uuTaed to produce Income-
PROPERTY OWNED BY CLAIMANT IN OTHER
County Township County Township
I hereby cenity the above statements are true, correct and complete.
Signature of claimant W p
Address (number street, dty`tJ tXe 6t / -ems C, ]-6 /V -S'7 / of O �C X 1141 7
ASSESSOR ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD NON-RESIDENTIA
AT 100% OF TTV I VALUE VALUE
Land not exceeding 1 (one) acre Immediatelyfsx
surrounding resitlential ice rovements.
Other land
(2)
µ =`
b`=
r•�{; -�,.
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
e' °>
Resltlen0al Improvements or Annually
Garage
Assessed Mobile I Manufactured Home
Other Improvements
(6)raE_%
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify above is true, correct,
Signature of Assessor
Date signed (ntonth, day, year)
and complete.
Verifying action - Signature of Auditor
Data signed (nronth, day. year)
STANDARD DEDUCTION
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or 545,000
Notwithstanding any otherprovision, the sum of the deductions provided m IC 61.1 -12 to a mobrfe home that is
5
not assessed w real property or to a manufactured home that is not assessed as real property may not exceed
one-09ff (1/2) of the assessed value of the rnobife home or manufactured home.
Signature of AWltor
Date signed (month, day, year)
d�.� �., CLAIM FOR HOMESTEAD PROPERTY TAX
;'""-y ' CREDIT/STANDARD DEDUCTION
:� State Form 5473 (R2/1-90)
�' '•�: � INSTRUCTIONS: See reverse side for Iiling instructions.
CERTIFICA
FORM YEAR
HC10 v
�5-ao39�
I(We) �v '�e�y that on t��day of March , 197 (Z
'(We) occupie as our p� incipal plac esidence the tollowing described real property for which a Homestead
I ,--,�
roperty Tax Credit is f�er�by �I�t�Ad: pG' i(We) owned ❑ Are buying under contract
� Have a ben�r t i th�e e�ntity that is liable for the property taxes on the property and that owns the
property or is buyiq��i8 tract.
CONTRACT RECORDED
If buying on contract. Fee Simpte Owner's Name
Recorder's office where coniract
PROPERTY DESCRIPTION
y Taxing District (City, town, township)
P�Su _L���I "D „�I Legal Description \ , `� � �II I I `rn ��
fz ) 1� lJl P��l� � lti� _-��
If any portion of ihe residential structure or ihe land not exceeding one (7 ) acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion of the property utilized to produce income.
�/_ _/�'-� � ��-�. 34� -a�/,
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Townsh�. �
---�—
`+ereby certify the above siatemenis are Vue. correct and Sig a re
.,omplete.
Address (Street, number. city. state and ZIP code)
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding 1(one) acre immediately
surrounding residential improvements (�)
Other land (2)
Total land - line (7 ) plus line (2) (3)
Residen[ial improvements Dwelling (4)
Garage (5)
Other improvements (6)
Total improvemenis - line (4) ihrough line (6) (7)
Total value - line (3) plus line (7) (8)
I hereby certify the above is true. Signature of Assesor Date Signed
correct, and complete
Verifying Action - Signature of Auditor Date Signed
1989 Pay 1990
sser of 1 /2 Homestead
Valuation or $2,500
STANDARD DEDUCTION ALLOWANCE
1990 Pay 1991
Lesser of 1/2 Homestead
Valuation or $2,000
1991 Pay 1992 19 — Pay 19 —
Lesser of 1/2 Homestead Lesser of 1/2 Homestead
Valuation or 51,500 Valuation or $1,500
Signature of Au itor Date Sfgnf
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