HomeMy WebLinkAboutHomestead_Stevens (4)S..'^ a CLAIM FOR HOMESTEAD PROPERTY TAX
S STANDARD / SUPPLEMENTAL DEDUCTION
Sta:e Portn 5473 (R72 / 6-09)
� ° Presmibed by Ne Depanment of Laal Govertvnent Firexe
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INSTRUCTIONS: See reverse side (or fiiirg ins(ructbns. " � ,Q
. .
��e� cerliy that I(we) ocaipied as my (our) prindpal
place of r idence or am (are) buying the ollowing described real property for which a Homestead Property Taz Standard Deduction is hereby daimed
under m ct on ihe tlate ihis applicatlon is filed, (dafe o/filing):
❑ I(We) am ❑ Am (are) buying under recorded conVact
❑ Am (are) entltled to omupy as a tenanl-stockholder of a cooperetive housing corporetion
� Have a benefidal interes( in Ihe Wst or Ihe nght to occupy Ihe property under the tertns o( a qualified personal residence irust
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Name of rlaimant (legal name)
So�l Seaafry nurtbri af � t(la5 fiue d'
Sodal Securiry numbel of tlaimanfs spouse (last five tligrts) Drivers ticense / Identifration / Other number Issuing State
o( tlaimanPs spouse (last five dg'ds)
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If buying on contract, Fee Simple ownets �ame
RecorOers offxe where mnVad is remrdeC Record number Page
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Caunry 7axnshiv 7anng distria (rity, rown, rowns )
Parcel number al desai0iion �/O � •�y � y���_
Rea� praperty ❑ AnnuaOy assessed rtnhile hamc (IC &1. f-7)
Y portion of Ihe residen•Jal sWCNre or Ne IaM no xceed'ug me (1) a�se that immediately wrtaunCS Ihac sWCW2 is used to P�� ��e. desrnbe Ihe use and portion
the property uo7¢ed to p�oduce income.
2+(0-/8-��f' a-o�-DDo• 8,57- o a. �
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Counry 7ownship Caunry 7ovmship
1 hereby ceNfy the above statements are true, correct and complete. Signawre of dalmam �
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Address (numDe� antl street,°N� sfate, antl Z/Pcotle) � �r�� in �� ��
�- /CO SYG'�QIG �i� . �r L
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Land nol exceeding 1(one) acre immediately �"v{ + t" +.: F�3`.,��:'�
5urtoundin re5identialim rovements. (�) �?' �t;+�,��?'3 h .R����.
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Other land (2) ~����o�.w �� �'`��-,
._..5. ��?i��:..
Total land (line 1 plus line � (3)
.�✓-�e+ rrr �a�tc. I z;ti �.
ResldenUallmprovementsorMnualty �elling (4) .��%��+q's g�,�S��y3:F,a�,,�.
0.uessetl Mobile 1 Manu(actured Home �a�ea �5) 3�.;����� w�,,� ,�'��� }�,�,s� �
Other improvements (6) x .�•'�`s''::`�� � �i
Total Imo�ovements (line 4 Nrough Ilne � (7)
Tofai value (line 3 pl�s line 7) (8)
I hereby certify ihe above is true, correct, Sigriarure of Auessor Date signee (monrA, Oay, ymr)
and complete.
VaifyiMj action - Signay2 of fwdtur Date signed (monN, tlay, �
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20 pay 20 Lesser o( 60% of the assessed value of Ihe homestead or 545,000
NMNthslaMing any olherpmvision. (he sumW fAe deductions provi0etl in IC 6f.1-72 to a rtrob�e fpme ihaf is g
not essessetl es realproperty w fo e manufadwed home fhal is not essessed as real properry maY �1 erceed
ane-he// (1R) W Ne assessed ralue of the mo0de home w manufaftured home.
SlgnaW otAUOitw n Date signed (rtpn(h, tlay, }ea�
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