HomeMy WebLinkAboutHomestead_Mason (27) > a, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
' , 8 STANDARD/SUPPLEMENTAL DEDUCTION FORM
r" -y Sox Form 5473Otnr me) HCIO
- Presented by the Department d lard Government France
INSTRUCTIONS:See reverse side tor fang instructions. -
NOTE Telephone,Social Seaaify,drivers license,state" . end tedeltlideratelifon numbers are a,nideo6el under IC e-1.1-12-37.
• I('We) pL CA 060 certify that I(we)occupied as my(our)principal
place of residence or (are)buying the • under contract for which a Homestead Property Tax Standard
e-. is hereby calmed an the date this application is signed, (date of signature). I(VJe):
I• • 0 Am(are)buying under recorded contract
■ (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust a the right to occupy the property under the terms of a quaffed personal residence trust
0 Am(are)the shareholder, partner,or member of the entity that owns the property.
• I - . - CLAIMANT'S INFORMATION _ - - '
Narneptslainsent geed�r0. o ?
.
Nam
t1 1C r' °A
Social Stony
)` _ CONTRACT RECORDED ,° .
If tope on oadan Fee Slope oafs Imne
Recorder's ogee where crteeds repealed Record number Page
Ceimy `• Taws* Tang dnaid(ray.tamlwrelip)
POro! legal snap=, Is the Meaty in question
0 Real property ❑A.vaney assessed nose lone(IC 6-1.I-1)
It any porton el the residential endure or en lad nal ermeectio one(1)ape t ai immediately strands aid n,more is used to produce income,describe 4e use at portion
of the pttaly dined to induce amne.
6 - 12. - 0 — A.01 — Ong
.E ar
- ":-4:_" -„PROPERTYOWNEDELSEWHERE BYCIAltlAY.T Yi- -. e_,' - ,
Sam,Cony.and Township Is daimw,t vacating a homestead?
❑ Ye, ❑ No
11//�aa�of clamant'
I hereby certify the above statements are trier.correct and complete./ ,' t (I
Address d aavma puce-ed ewe(dry..stale.and Woad.) _ d.amro am(randwalmee �,::xe•aezm >a 1a 0,1 P \Jr% �t�6
ASS R USE O ESSONLY -' - r ASSESSED VALUE M y.I HOESTE OYALUE L.1 ( N:R JOESIDENTIAL.
._ VALUE-z.._sri-:
Lend not exceeding one(t)acre Immediately v�'-o- z
surrounding residential improvements (1) �..;vi_ -.ii_s.,. v yr.
Other land (2)
Total land(line 1 plus line 2) (3)
x s
Residentiala improvements or (4)Re
annually assessed mobile I
manutachned honer Gang* (5)
Other improvements (b)
Total Improvements(line 4 through line 6) (7)
Total value (line 3 phn line 7) (B)
I hereby certify the above is true,correct Signature oiAsseswr Oats spied(moan.day,Year)
and complete.
Naturist raw-Strain dAudb Data Wiped(mas)].net lead
. . s I. :STAY:DARD DEDUCTION ALLOWANCE' -- - ,- _ ..
20 4, 20 L of 60%of the assessed value of the homestead or 545.000.
• •any other a sum of the deductionspm-tied inlc6.f.1-12 to a motile home -$ •
that is 22 ssed as real pm fy toa red home that is not assessed as real properly may
not et. . al(1/2)of the edCasa rmade home home.
sseDate (awxli Ty..4
aSTRIBUnON:Odom-ConyAu64;Fileacped Cony-Tegaye
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