HomeMy WebLinkAboutHomestead_MonierCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEnR
CREDIT/STANDARD DEDUCTION HC�o
` State Form 5473 (R817-07)
` Prescnbed by Ne Departrt�ent o( Local Govemment Firance
INSTRUCTIONS: See reverse side /orfi(irn� ins6ucfions.
I (We) �
� N'/B� OCGUPICd 35 OUf
w .• L i i v—ri v CefOry pla[ on lhe 15t day Of MarCh, 20_
place of residence the following described real property tor which a Homestead Proper�'�Credisis��y daimed:
1
I(We) owned ❑ Are buying under contrad
Have a berrefitial interest in ihe entity that is IiaWe fa the property taxes on the property and that owns the
If Wying om m�UacL Fee Simpa ownefs reme
oftice wMre mrNaa is recortlad
Recard number
cono-aa.
Page
Caunry TovmsND Taring district (cdy, town. tmmsNP)
Paicel �;mber Legal description � Is the in
�/� ^^ properiy' quesUOn:
� � ' OCV � � b• KbC � ❑ Real GruPerty ❑ Mobile Home (IC 6-1.1-7)
If arry porlion oi Ihe residerNal sVUCWre w lhe land not exceeding ane (i ) acre Ihat im�ately surtounds ihat stnic4ire is used lo produce income, descnbe Ihe use and pw(ion
oFihe properly NiEZetl to produce income. ^ _ I��O ��
us%►� �rn�
c�� /� �� �� 5� �/. v39�-�d .�
-.. . . : . .
County Tavnship County Twvnship
I hereby certify �he abwe statements are We, correct and complete. '9^�+re daimam
w
ess number ard s6eet dty, sbte, ane LP cvde)
� f �= �o �`T Qr�a..c tia ..i S� �G_�c8>.:_
�_ � . . .. . .
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Land not ex�rg i (oire) aae immediatety � - -- � : . '
surtoundirgresidentialimprovements. (�� ' - ' - � �
Other IafM �2) -
Tdai Wnd (line 1 plus line 2) (g)
Residential imprwements w Mnually �'eiling (q) ;' � - . .
Assessed Mobile / ManufacWred Home +. �
Garage �g� - ' -�� -
...�Y: vqJ( _
OtherimproVerttents (6) ;�::},r:.v'�,+ �"
Tatal improvements (line 4 through line 6) (7�
TUaI value (line 3 pl(s Gns � �g�
I h¢fBby CBfGfy Ne above is We. cOrtCtt. etfd Sigrature ofAssessa Date signed (monN. Cay. Yae�
complete.
Veifyirg actim - SfpnaWre MlWdibr
Date signed (mmN, day, yea�
�.-� � � • �
Y� pay 20 _ qs,ppp tor 2007 pay 2008 42,000 tor 2010 pay 2071
Lesser of 12 q,q ppp tar 2008 pey 2009 41.000 for 2011
Homestead Valuation �Y 2012 S
« 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature oflwtlitw Date sf9ned (manN. OaY.Y�