HomeMy WebLinkAboutHomestead_Martin (3)OCLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTALDEDUCTION
i State Form 5473 (R72 / 6-09)
° f Prescribed by the Departmerrt of Laal Gwemment F�nce
INSTRUCTIONS: See reverse Side fo� fiiirg inshuctions.
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FORM. '" YE�
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I(We 4 ceNfy Ihat I(we) occupied as my our) prindpal
place of residence or am (are) buying ihe following scribed real property for which a Homestead Property 7ax Standard Deduction is hereby daimed
,u-�ndper mnVacl on ihe date Ihis applintion is filed, (date ol fifing):
VJ I(We) own ❑ Am (are) buying under recorded contract
LJ �^ (are) entitled to oaupy as a tenant-stockholder o( a cooperalive housing mrporauon
� Have a beneficial interest in the Wst or the right to occupy [he property under the terms of a qualified personal residence Wst
Name af d' ni (legal name) Q
��QI'�E-y� `
sodal seaey
�``]�e.r� �� I
Sotlal Securiry numbu of Mant's spouu (Ws
- .
11 buying om m�traq, Fee Simple wmeYS �ame
RemNels a(&e where contreU is remtleE
Caunry 7c
Parcel number Le
1' �4r'f'1 tf
Drivers ficense / Identlfiraf
of da'unant (Wsf frve tlgiLS)
., I �f r'T t Y�
Drivers license / Identifration / OU�er number
of daimanCs spouse (last frve
I N
Recad number Page
rown, ro ip)
operty in puesGon:
t�al property ❑ MnuaOy assessed mo6ile home (IC &f. t-n
�t swmre is used to produca i�orne, desrliba �he use anE porrion
�i � 8�
.
Townsltip
I hereby certify the above stetemenis are We, covect and eomplete. I signamre ot daimanr
o�� w sa s �c
. ._ .
Land not exceeding t(one) acre immetllatey
surtounding residential improvements.
Otherlantl
Total land (line 1 plus line �
Residentlal improvements or Mnualty �Iling
Assessed Mobile I Manufactured Home Garage
Other improvements
Total Improvemenb (Ilne 4 fhrough line 6j
Total value (llne J p(`s Ilne 7�
I hereby certify the above is true, correct,
and complete.
Verif�ing ection - Signature ol fwtlitor
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�2)
(3)
(5)
(6)
���G
MAssessor
20 _ pay 20 Lesser o( 60% o( the assessetl value of the homestead or $45,000
NoNnNSlanding any ofiei piovision, Ihe sum o7the deductuns provided in IC 6-1.7-72 fo a mobde home Nat is S
rol essesscW as real property a lo e menNarlured home that ic not essessed as reel pmperty mey rot exceetl
one-haH (12) W Me assessed rdlue a/ Ne mobde home w manu/aGUrtd home.
sigfuwre ot aiditw
Date sgned (monfh, day, yna�
Date sg�0 (rtanN, day, yea�