HomeMy WebLinkAboutHomestead_Stonecrest Income and Opportunity FundC
E
7
i-�
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD /SUPPLEMENTAL DEDUCTION
s — Sate Form 5473 (1112/6-09)
�O Prescribed by the Department of Loral Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
j t i
MAY 2 0 2011
CFRTIFICATION STATEMENT
I (we)
certify that I (we) occupied y r) principal
place of residence or am (are) buying the following described real pro k" for which a Homestead Property TaaW$QN 006"i imed
ORR
under contract on the date this application is filed, (date of filing):
❑ I (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 temps of a qualified personal residence trust
CLAIMANT'S-INFORMATION
Nameofdama ( al name)
2j 4—tyc"
Social Secd* number
/�
Name of da' 's spouse (legal name)
Social S, -n num five digits) Drives license I Identification I Other
CONTRACT RECORDED
If buytrg on contred. Fee Si es name
�
n
LL/
Recorders office where convect is
Record number Page
PROPERTY DESCRIPTION
County
Township
Taxog d' cl aly, k
ip)
Parcel number
Legal description
Is the property in question:
I
property ❑ Annually assessed rteN1e home (IC 67.7 -7)
r If any portion of the residential structure or the Land not exceeding one (1) acre that Mmediately, surtou that stnuceure ¢used W produce Income, describe the use and portion
of the property utilized to produce income. -
�� -/� o%� 0oo. Sao -Oao
PROPERTY r BY CLAIMANT IN OTHER COUNTIES
County Township County -
Township
I hereby certify the above statements are true, correct and complete.
Signael of claimnt
IO amber and svee4 cpy, state. end ZlPo e)
L1X1 ' V
r
ASSESSOR ONLY
.
AT tt .
Land not exceeding 1 (one) acre immediately
surrounding residential improvements. (1)�,���w`....4✓_�
-?`+ -n c•�
Other land
(
ar?��Ymig
Total land (line 1 plus line 2)
(3)
Dwellin
r. <..
Residential Improvements r ed Ho
Assessed Mobile Manufactured Home
Garage
5
Other Improvements
(6)
�;�e�x, w
Total Improvements (line 0 through line 6)
(7)
Total value (line 3 p /rc line 7)
(6)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Audio,
Date signed (mordh, day, year)
STANDARD . r
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
'
NotwWWaMeg any otherproNsbn, the sum of the deductions provided th IC 61. 1-12 m a mobile fame that is
$
not assessed as real property or to a manufactured home that is not assessed as real properly may not exceed
on& had (1/2) of the assessed value of the mobile home or manufactured home.
Signature of Auditor
Date signed (month, day, year)
.- _�—r -c —s.