HomeMy WebLinkAboutHomestead_Gerling�'""� CLAIM FOR HOMESTEAD PROPERTY TAX
� STANDARD / SUPPLEMENTAL DEDUCTION
Sr ' Sfate Porm 5473 (R72 /6-09)
�O ° Prescribed by Ihe Daparimen� ot Loml Gwemment F�rcx
INSTRUCTIONS: See raverse side lor filing insfn�cfions.
. , � i ��:' 'i
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JUL 1 5 2009
I(We) � certify that I(we) s5n�/ifi�l prindpal
lace of residence or am are b n the followin e cri ed real ro e for which a Homestead Pro e Tax S���e .�Jie 2�hv'rr��ed
P ( )�M 9 9 P P hY P hY AUI�
,,,,,,u---///nd,,,e� coniracl on the date this appliption is filetl, (tlate of filiMj):
�I(Wej own ❑ Am (are) buying under recorded conVact
Am (are) enlitled to oaupy as a tenanFStockholder of a coopereWe housing corporatlon
� Have a beneFlCial interest in ihe Wst or the right ro occupy the property under ihe terms of a qualified personal residence W st
Name yfLtQimant (legal name)
Sodal Smriry nurtba of dam�ant (6st fise d+9ds)
Name at daimanfs spousa (
��
1f buying on conbact, Fee Simple awnrls riame
ReoorOels ofrrP where mnVap is remtled
Caunry
Pamxl number
9
Township
ivers Gcenae / Identifimlion
daimant (lasl frve d'giGCf
of daimant's spouse (las! five
If any portion of�asiEential strucWra w the IaM not exceed'ug me (1) arre that imn
ot Ne {uoperty etl to praEUCe irimme.
��-/g i� �oa-�. �'�/-oa�
Counry
Toxnship
I hereby certify ihe above statements are We, correct and complete.
�
Land not esceeding 1(one) acre immedlatety
surrounding residential improvements.
Otherland
Total land (line 1 plus line 3)
Resldentlal improvements or Mnualy �����g
Assessed Mohile 1 Manu(actured Home Garage
Other improvemenb
7otal ImOrovements (Ilne 0 fhroug� line 6]
Total value (Ilne 3 pl�s Ilne n
I here6y certify the above is hue, cortect,
and complete.
/viryi� action - Signature of Autlitor
(�)
�z)
(3)
(4)
(5)
(6)
18)
ofAssessor
rown,
20 pay 20 _ Lesser of 60% of Ihe assessed value of ihe homestead or $45,000
NplwiNStaMirg any other provivon, the sum o7the tleduclions proHded in IC 6-f. f-17 fa a mo6de fpme Nat a
rwf essessed as real property w fo a menuMrlurad hwne Net is rot assessed as real property mey not exceetl
ana-hatl /121 d fhe assessed relne of the mobde fame w manulactu2d F�arre.
Iswi�g
Record number
Page
ry in wesLon:
pmpeny ❑ MnuaOy assessed mabile home (IC &1. f-n
vcwre is used co produre I�rne, desmbe �he use aM portian
5
Township
[/�
Date signed (monN, day, yea�
Date si9ned (monlh. OaY. Y��
Dale signed (mOnlh. tldY. Y��)
,