HomeMy WebLinkAboutHomestead_Livermore (4) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
F .;a STANDARD/SUPPLEMENTAL DEDUCTION FORM
P �1: State Form 5473(117/1-16) HOW
Prorated by pe oepmvreea lnref Gaanm=Pewxa
INSTRUCTIONS:See reverse ado for nog n inxtrorn.
NOTE Telephone,Social Secwftj&Ner's Fcerae,state idenlihcafron and federalinertadcatan numbers are Wndderlal order IC 6-1.1-12,37.
CERTIFICATION STATEMENT
I(Wo) /ff/li.. i _ X11 CJ .•i s1, e certify that I(we) i)rti J\✓/
place of residence•e (are)buying the following desalted real property under contract for which a Homestead P �...
Deduction is hereby claimed an the date this appficjon is signed, (date of sign ). (Nk): .tp`1
®'Own. ❑ Am(are)buying under recorded contract \AO1 21
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the Nat or the right to occupy the property under the terms of a qualified personal residence Nat ai
❑ Am(are) the shareholder, partner,or member of the entity that was the property. ' 40— .kp1•Oft
- - •
Can Tomat �a j(ti)lawr.mahP)
L/{22 VJ'l 1'
Patel rumba Legal d""aSOtan -7 7� Is d�erp�opey Yin quails
not /�-1X// rmil/ LUREracPenr ❑Anuaynsvessadmotet 61.1-7)
If any carbmdThe molaiid aumasa ml araffi+gn (1)one ant Rm ysl+lvemds bier amrnaais�mpoQ®Nmni desaSe Me we arid GOrtbn
d the popsy Mired to practice insane_
c6 —//—/a - 0760-cc / . 1°Ja - c 8'
-- rc_. 2 _..::�PRORERTY OWNED ELSEWHERE BY,CCAIMANT.$ tin--- r' f l', �r
Sax.Cony,and Toeratp Is Raiment vacating a homestead?
❑ Yes ❑ No
Sigmas of daimat
I hereby certify the above statements are trim,correct,and complete. x n ', rj -re
Adds a caned(number-hi...-- dg,PP and ZIP-.._/ - --rd ranted any punter end street.toy gate.and EP code)
09 12oizurt) / i d9l 476
f ASSESSOR USE ONLY Tit. _ ASSESSED VALUE ;, l t HOMESTEAD VALUE"l. ,_ NDu VACUENTIALi
Land not exceeding one(t)acre Immediately 4- s
suoundmg residential improvements (1) -+
n
Other land t .{ fz4
Total land(line 1 plus line 2) (3)
Residential improvements or owning (4) 1 - K -Z'"'
annually assessed mobile/
manufactured home Garage (5) } r v --'liki-J,
Other improvements (6) i41:.;4L.f,?),-;d .t5°
Tonal improvements(tine 4 through line 6) (7)
Total value(line 3 phs fume 7) (9)
I hereby certify the above is true.correct, scrap a dA.•+-•a Data signed(rnwtq by,yea)
and complete.
•
Veiyby"Mon-Sgneuee dAUdbr Data signed(mash day-yee*
20_pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Nosdhstdafan any other provision,the sum of the led uctio s provided in IC 6-1.1-12 to a mobile home $
thatis not assessed as real pa:perry am a manufactured hone that is not assessed as seal pgOpedy may
not exceed onehal/(tld alga assessed value&the mobile home ornwa tar4wed home.
Slgabse of hafts 4 Di, Doe dpctl(Matt day,aaq
5/il ..:(o� u. ii-a 7-/7
DSTRIDU11ON Dr9lld-CaadyAs ddor.Re-Striped Copy-TaDafa
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