HomeMy WebLinkAboutHomestead_Mossberger (2)�
" CLAIM FOR HOMESTEAD PROPERTY TAX
! -.. . STANDARD / SUPPLEMENTAL DEDUCTION
� Stale Fortn 5473 (R72 / 6-09)
S,�,� � Presrlibed by Ihe Department of Laal Govemment Finance
INSTRUCTIONS: See reverse side for filing inshuclions.
FORM YEAR
HC70
� .
� ,
I(VJe) certiry that I(we) ocwpied as my (our) prindpal
place of residence or am (are) buyinq the following described real property for which a Ho stead Property Tax Stan educti0n�shereby daimed
under conUad on the dale this applintlon is filed, (dafe o/filin �/yr�`
9� OIB80N CO N7Y ��
❑ I(We) own ❑ Am (are) buying under recorded contract AUDITA�i
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing wrporation
� Have a benefidal interest in the Ws� or Ihe right to occupy the pmperty under ihe [ertns of a qualified personal residence Wsl
�• • •
Name o(daimant (I a )
U�
Soaal Sea�my rwm6er � Drivets license dentifintion / Other Issuing State
� of tlaiman� (la9 frve tligds)
Name of tlaimanfs s (legal name) ' �
-s�C�
Sadal Seamry nu ot daiman['s spouse (last five dgits) rivers ticensa / Id fxation / Other number Issuing State
� � of da'unant's spouse (last frve dig�) ��
• ••� �
11 buying om m�Vact, Fee Simple wmefs riame
Remrdels af4ce wliere mntraG is recnrded Recdd number Page
. . � • - � • •
Counry Taxnship Ta�dng disiriq (ci(y, lown, townshiP)
�[ �D � 2 Is Ihe p�o0erty in question:
6- ber �� `[.7, �a °� . J�-� � ❑ Real PmPenY ❑ AnnuaP/ asussed modle hame (IC S7. t-n
�tt any portirn U the re9aenw' 'Ae land not exrceding me (1) aae that immediately surtaunCS Nac strucWre is used to produce inwme, desaibe Na usa arN portion
or ma wovem �waea m pro� .
� a.as R�
... . . : . .
Counry Tawnship Counry TownsNp
1 hereby certify the above statements are we, correct and complete. Siynaw of tlalmam �
ress (iwmDer entl strret, riry, state, antl LPcode) •
/OLS2 GJ, /U00 S � : `!� 3
,. , � . .� . �
�� .. �
land not exceeding 1(one) acre immetliately f�;� ��^�s4� �(' �- ,±"`�
surroundin residentialim rovements. �» �:� ',..-�s_��3.4 �-��.�z:.;
Other lantl (2) �y=�?b�'' y,�"� �
7ofa1 land (line 1 plus line � (3)
Dwelling (4) i:�r�`.-.r�-i�'��.2',sy.2*'�'sS^'_��e",'
Residential improvements ar Mnualy �� � �r�"s �r °"°
Assessed Mohile 1 Manufac[ured Home "�- �*' a °�"'"
Garage (5) d���, �i ��.t:t��n^rr�e:�^�s�
T R
Otherimprovementa (6) • �.�.r4:'v�J���.
Total improvements (Ilne a througA llne 6) (7) '
Total value (llne 3 plls line 7) (B)
I here6y certify the above is true, cortecl, �"a�� °��05� �ie �'� (�"O��' �Y �
and complete.
Veritying acaon - SignaW re oflwditur Date signe0 (rtronN. Oay, yeai)
�..� � � • •
20 _ pay 20 Lesser of 60% o( �he assessed vAue of the homestead or $45,000
MoMi(AS1aMing eny olhe�provision, Ure wm at Ne tletlucfions provided in IC 6-f.1-12 fo a mob�le fqme Naf is g
mt assesseA es rasl pmperty w!o a manNeGUied hwne Na/ is rot essessed as real Pmperry may rrot exceed .
ona-hatt (1R) W Ne assessed value o/Ne moAile home w manu7aaumd home.
Signature of aNltar Date si9nea (month. day,lea�