HomeMy WebLinkAboutHomestead_Jostd�^'""� CLAIM FOR HOMESTEAD PROPERTY TAX
i; ._ ; STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R12 / 6-09)
�a � Prev;tibed by Ihe Department of Laal Govemmenl Finance
INSTRUCTIONS: See reverse side for filing instruclions.
FORM
HC10
��1LJ ��
YEAR
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� M'e) � certify that I(we) occupied as my (our) prindpal
place of residence r am (are) buying the f lowing descri6ed real property for which a Homestead Pmperqr Jax Slar�ar Deduction is hereby daimed
under conVacl on �he date lhis applifatlon is filed, (dafe o/(ling): ���Q`J. �S �.
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❑ I(We) own ❑ Am (are) buying under recorded contract C+�BSON COUNTY AUDITOR
❑ Am (are) enlitled to occupy as a tenanFStockho�der of a cooperative housing corporation
� Have a beneFldal interest in �he Wst or Ihe nght [o occupy the property under Ihe [ertns of a qualified personal residence Wst
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If buying om m�tract, Fee Simple axnefs riame
Recordefs oiRCe where conirad is remrded Remrtl number Page
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�nry Township Taxing distrid (city, rown, rownship)
�� p�y¢� !� ��� � Legal dewiDtion - Is ihe property in queslion:
�V � ,�J"'C� ��� � � Real property � Mnuatly assessed mobile home (IC &1.7-7)
�If any portion of Ne residential strucW re or the IaM not exceeding one (1) acre ihat immediately surtounds �hat sWCWre is used to pmduce income, describe ihe use and portion
of Ne p�operty uvfaed �o produce inmme.
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Caunry Township Couniy Tovmship
1 hereby certify ihe above statements are we, cortect and complete. n re w.daimam �
r
dress(numberarM reel, - sfate,a�e�Pcode) �/t �n ^� //�
!J'� '� 7
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Land not exceetling 7(one) acre immediately ?�'i?:�"�"'3q y��-.� "��� �
surtountlin residential im rovements. ��� :<?�=...--"a�"-'»`----k=�`= ^ � ��.-,��..-�--s�+�
t 3 4'� '�r'�
Otherland (2) � .y?.,,�{. ��;
7otal land (line 1 plus line � (3)
��.�'., -�^3"9^,�.r � $-2 i'- . �5 n.
Residenual improvements or Mnualry �eliing (4) q;�-�^'" �„£�'k°"��T.���;; �4
Auessetl Mobile 1 Manufacturetl Home Garage (5) -�+ � y 4 �,'� z`'��f T'�'�
�s�� �� f:s;fi'_
Other improvements (e) � ���' �"`_„ __ �- m
Total impravements (line 4 through Itne 6j (7)
Tofa1 value (line 3 pl,s line � (8)
I here6y certify the above is [rue, cortect, Sig�tura ofPssessor Date sgned (monfh, day, yea�
and complete.
Verifying action - SignaNre ofluitlitur - Da[e signed (month, day, yea�
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20 pay 20 _ Lesser of 60% of the assessed value of the homestead or 545,000
No(withslaMirg any otherprovisbn, Me sum of the deduct"ans provided in /C 6-7.1-f2 to a mobile home Ihat is $
irot assessed as real yoperty or lo a manuharluied home fhat is rpt assesced as reel pmperty maY �t erceed
one-h tl( WNeassessed✓dlu /Ne bdehomeormanu7actuiedhome.
' � ��e Date signeC (rtronN, Cay, yea�