HomeMy WebLinkAboutHomestead_Dillon_�," CLAIM FOR HOMESTEAD PROPERTY TAX
?; STANDARD / SUPPLEMENTAL DEDUCTION
S- State Fortn 5473 (R72 / 6-09)
�' ,��. ' Prescribed by �he Depanment o/ Loral Gmernment Fnance
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INSTRUCTIONS: See raverse side !w filirg instrucfions. ' A,AY '
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I(We) . (�(�w certify that I(we) oc�� my��prindpal
place of residence or a(ar buying lhe following des�ribed real property for which a Homestead Pm Tax rd DeducC i daimed
a�m
under mnVad on ihe d e lh" applicatlon is filed, (date o/�ling): �SON COUNT y qUD170R
❑ I(We) avm ❑ Am (are) buying under recorded mnVact
❑ Am (are) enlitled to occupy as a tenant-stockholder of a cooperative housing corporation
� Have a beneficial interest in the Wst or the right to occupy the property under Ihe [ertns of a qualified personal residence Wst
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Name of tlai t(lega/ name) �/'�( �
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Sadal Seamty nwriCer of daurian fne dig2s) Or'rvefs lusnse I
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Name of Uaimant's spouse (lapa/ namej
Sodal Secunry num6Pi of daimanYs spouse (lasl five d'gifs) Drivefs license / Identifiwlion / ONer number Issuing State
ot daimanYs spouse (last (rve dgits)
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11 Grying m wnbaa, Fee Simple ovmnls rame '
Recorders ofice where mntraa is remrtled Remrd numCer Page
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�nry TawnshiP Ta�dng d�sVUy (rity, tawn. rownshiP)
Paicel num6er Legal desaiD�+ Is Ihe property in question:
' � Real p�operry ❑ MnuaOy essessetl rtabile home (IC 6-1. f-n
If any portlon of the residential sirucWre w Ne IaM not exceedi�g one (1) arle that immeEiatey wrtounds that swcnire is used to produca income, desaibe the use an0 porrion
of Ne D�PanY utlfaeE m proEUce inmme. -
a�- ��-3� - �do-��� 9,� �a�
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Caunry Township Caunry TownsNp
I hereby certify the above statements are we, correu and complete. re of daimant �
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ress(iwmDerandstree4�i;��e aMLPCOde)
1 i1au1 87SS P e.,. ��633
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Land not exceetling 1(one) acre immeatately `4:?'.` �'��* 'N'" ^�"'t'� Y i� '_
sunoundin residential im rovements. (�) � +"-��t`»'-'�'}=2x`��-�"=�§*+;
Other IanC (2) ��'M`���`��' H
Li^�k�-...'�F ie .
7atal land (line 1 plus line 7) (3) �
Dwellin tr'si•�'�i�^.�S'.. ''�^+f.-,.��i
ResidenUal improvements or Mnualty 9 (4) ��'�r ''�3' -°�-���.5�+,�� �r�
Assessed Mohile I Manufac[ured Home Gaa e � t��'�� �{�r�hi Y ��'�� �
9 (S) ��s'��� ae.a.u�"r�a-F�--`:r�i
i'`':Y ' S� � 1��
Other impmvemenb (6) �+„+ .,�`,�
Total Imvrovements (line I through line � (7)
Total value (Ilne J phs Iine 7) (B)
I hereby certify Ihe ahove is true, cortecl, Sre"a� °��e� ��e �� (m�1h' dzy year)
and complete.
Vnifyi�g aman - SiBnayre of PLditw Date siBned (rtronN. tlzY. Y��)
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20 _ pay 20 _ Lesser of 60°� of Ne assessed vatue o� ihe homestrad or $45,000
NaNnlhslaMing eny ofherprovisbn, Ne sum of Me tletlucL'ons provided in IC 61.7-72 ro a rtmb�e fame Nat ic $
nat axsessed es real propeM or to a manufartuled home Nat is rot assessed as real propeM �Y �t exceed '` �- � -�
ane-ha// (1/1) W Ne assessed value o1 Me mobile home or manWaUUrad home.
SignaWre of Autlitnr Date signetl (monlh, day, yea�