HomeMy WebLinkAboutHomestead_Mossbergerg"'",� CLAIM FOR HOMESTEAD PROPERTY TAX
i, - STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R72 / 609)
° � Prescnbed by Ne Deparirtrent ol Laml Gwemment F�nce
INSTRUCTIONS: See raverse side for filing instructions.
F YEAR
� �
MAR 1 9 LUIU
I(We) �7J ,(iL�./ BS�yEnTol��e�my(our)prindpal
place of residence or am (are) buying the following described real operty tor which a Homestead Property Tax Standard Deduclion is hereby daimed
under conirad on the date Ihis applintlon is filed, (tlate oI filing):
�(We) am ❑ Am (are) buying under recorded.conVact
Am (are) entltled to occupy as a tenant-stockholder of a cooperetive housing wrporetion
� Have a beneficial interest in the Wst or Ihe right W occupy the pmperty under ihe terms o( a qualified personal residence Wst
! �3s)
spouse
It Guying am m�tract Fre Simple a.mers rame
RemNers office where mntraa is remrtle0
Caunry
Drivels ficensll IdentiFnt
o( daunant (last frve
Drivefs license I Identifiration / ONer number
of daimanYs spouse (WSl five ddgi6)
ParcG number I �j / /,� J� �V '� _// '7. �
/V !X
If any portan d Ihe residential sWCnire or Ne IaM not exrcedtrg me (1) acre Nat i iatey su
of the property wTaed m produce iMnme.
d �-��-ao-�d� -�a� a90 -oa5
... , , :
Counry Tovmship Caunry
I hereby cerlify ffie above ststements are we, correct and complete. I Sigqamre
�
Mdress (num6er antl 5Gee1, ciry, state, ard ZlPOOtle) ['`�
i.
Land not exceeding t(one) acre tmmedialety
sunounding residential improvements.
Othetlantl
Tofal land (line 1 plus line 2) .
ResidenUallmprovementsorMnualty �Iling
0.ssessed Mobile I Manufactured Hame Ga2ge
Other improvemenu
Total Impravemen� (Ilne 0 Nrough line �
Total vatue (Ilne 3 pl�a Ilne �
I hereby certify the a6ove is true, cortect,
and complete.
Verily'u�g aam - SignaS�re of PLtlitor
w
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�z)
(3)
(4)
(5)
(6)
(B)
SigreNre of Assessar
State
Remrtl number � Page
rown,
Is e peRyinqueslion:
Real pmperty � Mnua�y assesseA modle home (IC 67. f-;
�s Ihat swcnire is used m proCUCe u�arne, Eescnbe �he use and pwdrn
20 pay 20 Lesser of 60% of the assessed value of ihe homestead or $45,000
NoM1VilhsleM'vg any alherprovision, Ne sum ol tlre dedixlionc pro�nletl in IC &1.1-12 ro a mobde home Ihat is
nat assesseC es real properry w fo e rtunu/aCUred home Ne� is riW assessed as ieal property may irot exwed
one-haH /f210/ Ne essessed rdlue o/ Ne mobde hortre wmanufarluretl hrnie.
en rv�
:�
Townslup
y7
Date signed (month. daY. l��)
Date spned (monM. daY. Y�)
Signature ot Nitlliw �. � Date signed (rtanth, day, yea�