HomeMy WebLinkAboutHomestead_Friedmand�'"' CLAIM FOR HOMESTEAD PROPERTY TAX
� ?; STANDARD / SUPPLEMENTAL DEDUCTION
� i. State Form 5473 (R72 / 6-09)
�' ��� 1` Pmuribetl by the Departmenl of Local Gwemmenl Frence
INSTRUCTIONS: See reversa side for fifing instructions.
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I(We) �� qh J Y6p./Z,{,AJ �.�[ �Z.1[�j �'aiT(vie) ocwpied as my (our) prindpal
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place oF residence or am (are) buying the following described real property tor which a Homestead Property Tax Standard Deduction is hereby daimed
under conVaU on ihe date Ihis appliration is filed, (dafe oI filing):
❑ I(We) own ❑ Am (are) buying under recorded mntract
❑ Am (are) entltled lo oceupy as a tenant-stockholder of a cooperafive housing corpore[ion
� Have a beneficial interest in the Wst or the right to occupy the property under the terms of a qualified personal residence wst
•• • •
vn daimant (iegal name) `
.,i ✓,�.f Sr � ti�1�.��J .
Drivefs ficense ! IdnnVfirat
of da'unant (las! frve tligiGt)
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spouse (last five tl'grts) Olivers tirEnse / Identifkation /
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11 buying om m�tract, Fee Simple ownefs name
ReooNers o(&e where mntraa is remApq �_' ^_/� /�' 1'� �•
�x X o� "; y
Counry
Parcel number
If any portion ol Ne residenilal str
pf Ne PmPertY w'f¢eG m pratlure
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•31`1-
LegalOescriplion / A i
PT S a7 -3 -i l /6
: an ' imm
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�r. _ - unn_
Counry \ l iownship
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I hereby ceNfy the above statements are we, cortecl and complete.
Atltlress (num0er antl street, rify, 5(ete, aM ZlPcatle) /�
s S"2A //) 9�s.i .R �• /_4.e,.a�.e.�., t-L'i� - �
Land not exceeding t(one) acre immediatety
surtounding resldential improvements.
Other lantl
7otal lantl (line f plus line �
Residentlal improvements or Mnualy �"eliing
Assessed Mobile I Manufacturetl Home Garage
Other improvements
Total improvements (line 0 throng� Ilne �
Tatal valua (llne 3 phs line 7)
I hereby certify Ne above is hue, cortect,
and complete.
Vailying action - SignaNre ofluidibr
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(2)
(3)
(4)
(5)
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Sigruh�re of Assessor
Caunty
wDertY in 9ues�iwr.
Realproperty
�eiavsed
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of tlairtant
Issuing Stat��
Remrd number Page
AnnuaAy asvssed tmhile Iqma !IC &t t-
u�mne, Oescnba �he use ard portron
Oate signed (rtronN, Eay, yea�
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Nolwifh5laM"ug enY �er P��sb�, the.wm d the deductions provitletl in IC G7.7-12 fo a mobda fame /haf is g
rwt assessed as ieal property a lo e menulurtured hwne lhat is rpt assessed as leel pmperry may nof exceeC
one-hall (72f o/Ne assessad valua o11he mobde home or manulacturetl hwne.
gnaWre W Pudltw � � Daie signed (rnm(h, day, yea�