Homestead_Smith11
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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
S I State Forth 5473 (R1216-09)
Prescribed by the Department of Local Goverment Finance
INSTRUCTIONS., See reverse side for riling instructions.
Nat)YEAR
JUL 2 2 2011
CERTIFICATION STATEMENT
/
certfy
�h opal
of r s' ence or am (are) buying the follovring described real property for which a Homestead Property Tax nand section Is ereby claimed
Sia d�
7under
co don the date this application is filed, (date of filing):
❑ I (We) awn ❑ 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
Nameof 1 Ina
7f i
Social 60ultl
Social Security number of daimant's spouse (last five digs) Onmes, license / Identification I Other number
Issuing State
of daimam's spouse (last rive digits)
CONTRACT ••r
If buying on contract Fee Simple owners name
Recorders office where contract is recorded
Record number Page
PROPERTY DESCRIPTION
County
Township
Taxing Ai ct
. t ip)
(!'whir
Parcel number
I description
Is the property in question:
1 property ❑ Annually assessed mobile home (IC &1.1 -7)
If any portion of the residential am rc um or the land not exceeding one (1) acre that iatBly su t suucwre is used to produce income. describe the use and portion
income.
ed, to produce income. /
of the property utilizze
.
�f
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
n
Address (number and street, clA: state, and ZlPCade)
a c s t aesF '9 -7 Wo 6
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE
I HOMESTEAD NON-RESIDENTIAL
AT 100% OF Try
I VALUE VALUE
Land not exceeding 1 (one) acre Immediately
surrounding residential improvements.
Other land
(2)•.
Total land (line f plus line 2)
(3)
Dwelling
(4)
'•'L'•4
�"ti— ''=' --•r-
ResidentialimprovementsorAnnually
Garage
5
Assessed Mobile I Manufactured Home
Other improvements
(6) -
N ry
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
hereby certify the above is true, correct,
Signanae of Assessor
Date signed (^month, day, year)
and complete.
Vailying action - Sign teme of Auditor
Date signed (month, day, year)
STANDARD DEDUCTION
20 pay 20 = Lesser of 60% of the assessed value of the homestead or 545,000
AbAvVistandug any other provision, the sum of the deductions provided in /C 6- 1.1 -12 to a moble home that Is
$
net assessed as real property or to a manufactured home that is rot assessed as real preperty may not exceed
one -half (1/2) of the assessed slue of the mobile home ormanufartured hone.
Signature of Nrditor
Date signed (month, day, year)