HomeMy WebLinkAboutHomestead_Henderson�'"'" CLAIM FOR HOMESTEAD PROPERTY TAX
s. � STANDARD/SUPPLEMENTALDEDUCTION
i•: ' State Form 5473 (R12 / 6-09)
°' l PresctiDetl by Ne Departmenl of Local Govemment Frmrce
lNSTRUCTIONS: See raverse side for filing instructions.
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MAY 1 '7 2010
I (we) • certify thta?I't�f�+P�YnY11Am9ROf�Pa�
place of residence or am (are) buying Ne following described real properry tor which a Homesiead Property Tax Standard Deduction is hereby daimed
under mnVaa on the date this application is filed, (dafe o(fifing):
❑ I(We) own ❑ Am (are) buying under remrded conUact
❑ Am (are) entltled ro occupy as a tenant-stockholder of a cooperetive housing wrporation
� Have a benefidal interesi in ihe [rust or [he right to occupy Ihe property under the terms of a qualified personal residence trust
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Name of aimartl (kgal name) �
��� o( dahnanl (4sf fie tlig3s) ol da'man��(kst/�rve d'g�'�JWn / �� Issuing Stale T�
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� (legel neme) '
Sodal Seariry num6er o1 daimam's spouse (last frve dgrts) DriveYS IirPnse / ICenGf�tion I ONer number Issu'vg Slate
ot tla'unanPS spouse (last frve dgiGS)
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If buyirig om m�trad, Fee Simple owners reme
Recordefs ofice where conlrect is recoNed RecoN number Page
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Caunry Tawnship Taring disirid (cifY town. (ownshiP)
PamxJ number Le9al desmiP� " � L Is property in qu
' � �y � ,3 � � � ❑ Reai property � � MnuaOy assessetl rtwbile home (IC 6f.1-7�
�If a�ry portion of Ne resldenUal SWCW re w the land rwl excee0ing ane (1) aae lhai ImmeCiately surtaunds ihat sWCWre is used to produra ircarne, desaiba Ne use aM portion
of Ihe p�operry utSaeC m pladuce income.
a�� �7-09 -�oo-ool. �lo�-oa/
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Caunry Trnmship Counry Township
I hereby certify ihe above statements are we, cortect and complete. Si ra oi daima � �
Address� d /i �O /� , slsf ��Z1Pgde1� OW"' SV / /� �--J-�/�/ � / (!/ (.c J
W J
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I.and not exceeding 1(one) acre immediaury � y�*'�,y..,.,,��_ �.,, "�,�'�-„
surtoundin residential im rovements. ( � �-�-0 Y�3--=-�-?*`*=+��`_— ��-=E'-t
Other land (2) y`� �'�.�i�p��'
Total land (line 1 plus line � (3)
Dwelling (4) . .•�.a%a�-r'�w7rg d-�- ;w ._
Residentlal Improvements or Mnualty �'�� '~j ��'��"� r- rE �"'"
l�ss�sed Mobik I Manufactured Home Gara e �'�'s'x v ��� �"� �`4 `',:o-
9 �5) ��r .*'`r._@.���i�Y.��.,.
;,a-.�.Y.:;+Y'y•� '
.�����;:.h�t .�'a�t
Other improvements (6) ;.�.,�-s,, .�r. _,�°; ,�,. -;
7otal improvemenb (Ilne 4 through line 6j (7)
Total value (1lne 3 plls llne � (8)
I hereby certify ihe above is true, cortect, Signawre af nssassor Date signetl (month, day, yea�
and complete.
� Vaifyirig ac6on - Signawre ofluidita Date signed (monN. day, yea�
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20 _ pay 20 � Lesser of 60% of the assessed value af lhe homestead or 545,000
NofwifASlaMing eny ofhei/w�isim. Ne sum W Ne detluctions providetl in IC E7.7-12 (o a mo6de home Ihaf is g
rot assessed es real pmperty w fo a manulertured hwne fhet is nof essessed es real praperry maY �1 ermed
one-haH (72) W Ne assessed vdlue W tAe mobde home or menutdtluretl frome.
Syrewre d AuElinr � Date v9ne0 (rtionlh. daY. !'��
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