HomeMy WebLinkAboutHomestead_Gardaa"a CLAIM FOR HOMESTEAD PROPERTY TAX
`' �` STANDARD/SUPPLEMENTALDEDUCTION
�2 Sta,e Fwm 5473 (R73 / 12-09)
�' Prescribed by �he Department of Lowl Govemment Finance
INSTRUCTIONS: See reverse side Ior filing instructions.
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F � � YEAR
.�CtU_; ,l. �� �°
MAR 4 �;;�,�
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I (VJe) � ce� my (our) principal
place of r i ence or am (are) buying the following described real property for which a Homestead Property T�tan a��u�t�i��F�P�j Gaimed
under co act on the date Ihis application is filed, (date o/ filing). I(We):
fy� Own ❑ Am (are) buying under recorded contract �
`_� Am (are) entitled to occupy as a tenani-stockholder of a cooperative housing wrporalion
I❑ Have a beneficial interest in the trust or the right to occupy Ihe property under the terms of a qualified personal residence trust
❑ Am (are) ihe shareholder, partner or member of ihe entity that owns the property.
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me of d' t(legal name)
Sotial ', num /o�� tlaimant (last frve d'gr,$) Dnver's license I Identifcation / Other
Sotial Sewnry number of daimanfs spouse (las( frve Oigits) Drivers license / Itlentifiption / Other number Issuing Siate
of Gaimanfs spouse Qast frve dgits)
If buying on conVact unple o mefs name /� / /
vL �� �a S CO �S
Reco s o:5ce vA�= Vact is recorde Record n ber Page
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County - � . axin is nct city, wq township)
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�el n r �7� Legal descriplion Is the pro erry .n question:
/� Q�,/ ci�0 ��%d � � eal roperty Annually assessed rtwbile home (IC G1.7-n
f any portion of the residentlal strucWre or �he land not exc ing one (7) aae Uiat immedia;ety sunounds that swcture is us b protluce income, descri�e Ne use and portion
of Ihe property utiiized to protluce income. /L �/, �
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Counry /� h/ Township Counry ' Township
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I hereby certify the above statements are true, correcl and wmplete. Signawre.of Uaim�n
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Address (number antl streel, ciry, state, and ZlPCOde) � �/
5'-t5� c C2 (05o rJ I-FA-ZeI-�c,�S 2�; �-11 ��l f�.
�. � � . •� . �
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Land not exceeding 1 (one) acre immediately � � - � - ' � �
surrounding residential im rovements. I��� ( I -
Otherland (2) I ' ' - ' � �
Total land (line 7 plus line 1) (3) I
Residential improvements or Annually Dwelling I(4) I I "
Assessed Mobile I Manufactured Home Garege I(5) I
Other improvements (6) ^ � �
Total improvements (line 4 through line 6) (7)
Total value (line J phs fine 7) (8) I
I hereby certify [he above is [rue, correc[, Signature of Pssessor Da;e sgned (month, day, yea�
and complete.
Venfying aclion - Signature of Fwditor Date sgned (month, day, yea�
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