HomeMy WebLinkAboutHomestead_Racine CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD I SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R15/S16) HC10
• sle• Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. .
NOTE:Telephone.Social Security,driver's license,slate identification and federal identification numbers are confidential under IC 6.1.1- 7.
T`\ 1 ,` ,CERTIFICATION STATEMENTi.? '' '.T. f2.---Y 7.,--.,,4-1;i
I(We) Air///ej.�Lafa t • I certify that I(we)occupied as my(gyrlpnnclpal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property tW'4al [d
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):a / 2 is
❑ Own. ❑ Am(are)buying under recorded con7act. 0j l,
•
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. SO
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal r -y 'T.�- j r
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. • 7A
•
If buying on contract.Fee Simple cwx(s name
Recorders of5ce where contract is recorded Record number Page
arc&$:-IT:A 4 it,i --,-r PROPERTY:DESGMOMON4.- `L1 :3,M? -i' .-- e+�
catty / Township Tan •dire tasm.thq)
Par- -r Legal desmp:ion Is the q in question
- /e?-/7/03-00 3. d/3-602 a' Real property ❑ Annually assessed moale Mme(IC 61.14)
If any potion of the residential saumrre or the land not exceeollg one(I)acre that immediately sumo ds that=cure C used to produce income.desc oe the use and cation
of die,...tv:.1 ubl ed to produce Income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
San.cwrcy,and Town tip Is claimant vacating a homestead?
❑ Yes ❑ No
Signatu I claimant
I hereby certify the above statements are true,correct,and complete.
- /', Q . / _ /
- e
Address of contact to mher sal tee(cdy..state.and ZIP code) Address. vacated homestead,d any(number an s-reet,dty, ate a • -..e)
?CI U ' & Sow 4u C_ vc. l., rwb /70 I
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NOIMESISIDENTIAL
Land not exceeding one(1)acre Immediately 11)
surrounding residential improvements
Other land I(2)
Total land(line 1 plus line 2) I(3)
Residential improvements or Dwelling (d)
Annually Assessed Mobile/
Manufactured Home Garage (5) I
Other improvements 1(6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct. Signature of Assessor Date signed(rrm:q dog year)
and complete.
Vs:lying action-Signature of Audacr Date signed(month,day,year)
-;.r --y-'.¢_` ' C_a''';, ` - .- -.: STANDARD DEDUCTION ALLOWANCE x ? =��`*_ e rapa'=`,;
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Nobvithstanding any other provision,the sum of the deductions provided in/C6-1.1-12 to a mobile home S
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-hall(12)of the assessed value of the mobile home or manufactured home.
Sgnatse of Aud for Date signed(rn t,day.year)
DIsTRrnusiod:Ong nal-County AWtor.Fee-Vamped Copy-Taxpayer