HomeMy WebLinkAboutHomestead_Freeman�CLAIM FOR HOMESTEAD PROPERTY TAX
� STANDARD/SUPPLEMENTAL DEDUCTION
1 �� State Form 5473 (R12 / 6-09)
° ° Prewibed by Iha Department of Loml Govemmeni Frience
INSTRUCTIONS: See reverse side lor filing inst�ucfions.
FO �
HC10
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� M�e) / r��r� � �� ��� yYi % �f/1. Q��� certify that 1(we) ocwpied as my (our) prindpal
place of residence or am (are) buying the following described real property tor which a Homestead Property Tax Siandard Deduction is hereby daimed
untler conVact on the date this appliqUon is filed, (date of filing):
❑ I(We) own ❑ Am (are) buying under recorded convact
❑ Am (are) enliLed [o occupy as a fenanFStockholder of a cooperative housing corpo2lion
� Have a beneficial in[erest in the Wst or the righ[ to occupy the property under ihe tertns of a qualified personal residence Wst
�1
UmeYS Icenu I Itlenti:
(lav frve digifs) I Omefs license I
tl buying om m�tract Fee Simple wmefs rume
RemNefs afire where contracl is reco�ded
Counry
Partel number
aesaivtion
V7 NE S� 4-3-,
' any ponion of the 2sidentlal swcwre w Ne W�M not exceeding one (1) arre thaf
J t�e properry u�f¢ed to proEUCe inmme.
ITa�ting d'atrid (city, town, tounshiP)
tl. C' i I Is N^7mPerty in question:
w.
15suing $tate
RecorC number I Page
_� � Real property LJ AnnuaOy assessed rtw6ile home (IC &f. f-n
surtountls Na[ sW cWre is useC m protluce i`roome, dewibe lhe use and portion
2�-I`�-Oq,3oo• oo/. �y,3 -o �S
.,. , , :
Counry Townsttip Couny
I hereby certify the above statements are we, corzea and compiete. I Sigria` re oi naimam
(number and sheet, ary, sta;e,
Land not ezceeding 1(one) acre immediately
surtounding residential improvements.
0lherland
Total land (line 1 plus line 2)
Residential impravements or M
Assessetl Mobi�e / Manufaauretl
Olher improvements
(�)
(2)
(3)
Dwelling (4)
Garage (5)
Total Improvements (Ilne 1 th�ough line 6j
Total value (llne7 plus line 7)
1 hereby certiy tha above is true, correct,
and complete.
Vailying acUan - SignaNre of Autlitw
�)
(8)
SignaW re of Assessor
20 pay 20 Lesser of 60% of Ihe assessed value of the homeslead or $45,000
Nohvithslandirg any o(her pmvivrn, the sum o/Ne deCUrlions provi0etl in IC E7.1-72 to e rtrob➢e home Nat is
mt assessed es real popeM w to a menufeclured hwne that is not esseued es real pmpelty may rot exceeA
of P�C,tor �
�
$
Date signetl (rtronN. tlay, yea�