HomeMy WebLinkAboutHomestead_Kolley (2)f1
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CLAIM FOR HOMESTEAD PROPERTY TAX
3 _ STANDARD /SUPPLEMENTAL DEDUCTION
State Form 5473 (R12/6-09)
'O Prescribed by the Depannrent of Local Government Finance
INSTRUC77ONS: See reverse side for filing instructions.
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CERTIFICATION STATEMENT
I (We) certify that I (we) occupied as my (our) principal
place of residence or am (are) buying the following described real roperty, for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
❑ 1 (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 terms of a qualified personal residence trust
INFORMATION
Name of nt (lergal name)
Social Security number of claimant's spouse (last five digds) Driver's license I Identification I Omer number
Issuing State
of dahnam's spouse (last five dill
CONTRACT ••• r
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number Page
PROPERTY DESCRIPTION
County
Township Taxhug distdd M, town, township) township)
/1/1*1 V
Parcel number
Legal description -An L $ JO Z14
Is the property in question:
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❑ R-1 property ❑ A.—By assessed nwWe horse (IC 6.1.1-7)
If any portion of the residendal structure or the Ldnd not exceeding one (1) arse that immediately surrounds that structure is used to produce income, describe the use and portion
ofJthe property utTaed22to producee7'uvnmee..
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o&—AI-3. - -30" -7 ,90r
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County icwmship
I hereby certify the above statements are true, corect and complete.
Signs{h i f I
Address (number and sheet, city, sate, and Z/Poode)
8 E. ' o L17 66
ASSESSOR USE ONLY TRUE TAX VALUE ASTS E So '
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Land not exceeding 1 (one) acre Immediately
surrounding residential improvements. (1)u:x'y" ,c:
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling -
(4)
Residential Improvements or Annually
Assessed Mobile l Manufactured Hone
Garage
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a x"- 'Y"•7'
Other improvements
(6)
Total Improvements (line 4 through line b)
(7)
Total value (line 3 plus line 7)
(B)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
a nd complete.
,
Verifying action - Sgmhire of Auditor Date signed (month, day, year)
STANDARD r r
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or 545,000
Nolwithsland, g eny ntberpnnmon, the sum of tie deductions provided in /C 6- 1.1 -12 to a noble home that is $
not assassed as real property or to a manufactured hone that is nor assessed as real property may not exceed
one-half (12) of the assessed value of Me noble home ormanulactured hone.
5 nature W Auddo
Date signed (month, day, year)