HomeMy WebLinkAboutHomestead_Vermillion�`"'" CLAIM FOR HOMESTEAD PROPERTY TAX
i4_,. `; STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R72 / 6-09)
�� � Preuribed by t�e Department of Laal Govemment Fna�e
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INSTRUCTIONS: See raverse side for filing instmcfions. . A V G 1 9 1 �q
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I(We) cerlify that I(we)�Die�i1 �dqur) prindpal
place of residence or a(are) buying the following described real property for which a e d pe 7aJ;}� Qard Dedilalion is hB�y daimed
�un/dermntracl on �he date U�is application is filed, (date offili �QQ """'ON COUNTY AU61i6S
�'I I(We) own ❑ Am (are) buying under recarded conVaIX
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� LJ �(are) entl0ed to omupy as a tenan4stockholder of a cooperative housing corporation
� Have a beneficial interest in ihe Wst or the righ� to occupy Ihe property under the terms ot a qualified personal residence trust
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N o( t(kgal ) � �
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Sodal Seamty number Orivels ficense / IOentificatbn / �� Issu'vg S�
o( da"unant pas( five dqits) �.SGi�
N e ot nCs Qegal neme)
Sofial5 riry number of ' its) Dmels license / Identification l
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It buying om m�traG, Fee Simple ownefs �ume
RecoNefs ofirP where mnVaa is remNeO Remrd number Page
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���y Township T' 4' vict (ciry, tovm, township)
Parcel number C �Otion I5 Ihe �operty in qu 'on:
�� ��j�- �-�0 Real proprity ❑ AnnuaP/ ass�sed mo6ile home (IC &1. f-n
If any W ihe resdentlal shucture or Ne IaM nol exceeding a�e (1) acre ihat immediatety wrroun s ihat swmre is used tn proEUCe income, des�ibe Ihe use ard portion
of Ne perty ubT¢ed b pmAUre inmme.
a�- /�'-09- 3oo_ooa. a�saa�
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Counry Township Counry Tovmsltip
I hereby certify the above statements are We, corzect and complete. S' o m �
Address (numbeIr a,M strGeet, ciry, s�ete, aM ZlPCade) /'
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Land not esceeding 1(one) acre immediately (�� 7�`i�+"p.r y# �?�?�y�"�`"�j��:;
surtoundin residenUal im rovements.
Other lantl (2) �n. �. �?'`� ���e .
Total land Qine 1 plus line � (3) .
_ ....,. Dweliing (4) �?'�lie��.�.�,-e'�X�+s� +�s-`'��;
Residentlal improvements or Mnually .
Auessed Mobile 1 Manutactured Home Garsge (5) r,:z ;'� `.��w� �� +.'�+Y'n.'# a":
- . i a.t 5>-•: •
Other improvementa (6) � 35y1��_'
Total Improvements (llne 4 NrougA line 6j (7)
Total value (line 3 plla line � (B)
�I herehy certify ihe above is true, cortect, Sg"a� °f �u0r oa;e signed (mmtn, day. year)
and complete.
Veityifg ac6on - Sigruture of AutliWr Date siBneC (rtronfh, day, yea^
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20 _ pay 20 _ Lesser o( 60% of the assessed value of the homestead or $45,000
Ab(wiffufandin9 any otherP��n. Ne sum W Ne detlurlionc prorided in IC 61. f-12 to a moWle lame Nat is g
not essessed es real property ar m e manufaGUred frome Nat is mf assessed es reelproperry may irot exceed
ono-hal/ (iR) d Ne assessed value of the mobde lame w manu/acmreG frortre.
Signature W hMitnr Daie signeC (month, day, year)