HomeMy WebLinkAboutHomestead_Zenthoefer (3)* CLAIM FOR HOMESTEAD PROPERTY TAX
rt � STANDARD / SUPPLEMENTAL DEDUCTION
� ^ State Form 5473 (R72 / 6-09J
S � Presuibed by the Depanment ol Local Gwemment Fiairz
fNSTRUCTIONS: See reverse side !or fil'ug ins(ructions.
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MAY 2 4 2010
� (VJe) • certifY tIgIB6�►b�i�d'6YrA�UOi�QR�dpal
place of residence or am (are) buying Ihe fo wing scribed real property f ich a Homestead Pmperry Tax Standard Dedudion is hereby daimed
under conUact on the date Nis application is filed, (date o/filing):
�I (VJe) own ❑ Am (are) buying under recorded conVacl
Am (are) enli[led lo occupy as a tenan45tockholder of a cooperative housing corporation
� Have a benefidal interest in the Wst or Ne right to occupy the pmperty under ihe tertns o( a qualified personal residence Wst
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Narne of t Q 1 name)
Socal Securiry nwiber of dau`ant (last digtls) D�ivels ficense l lden' ibn / ONer number ///��� Issuing Slate
Sadal Securiry numErl af tlaimanCs spouse (lasf five tliprts) Drivels license / Itlentifratian / Olher num6er Issuing State
of da'unanCs spouse (las( frve dyiGy
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116y4ig on contract, Fce Simple owners riame '
Reoo(defs of&e where mnUaU is recoNeE RemN num�er Page
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County Township T'ng d'atria (rily, fown, fownshiA)
Parcel number Legal EesoiO� I Is e pmperty in Question:
� l — eal proverty ❑ MnuaDy a55es5e0 modle home (IC b1./-n
�If any poM1ion of Ne resiAential sWCWre or IAe Ia�M rrot exceedvg me (1) arne lhal immetliateJy su�mu s that swcn�re is used m pmducre irnnme, desmbe Ue use and portion
ol Ne property uN¢ed to pmduce income.
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Counry Township Counry TownsAip
1 hereby certify the above statements are We, correct and complete. signature daimant �
Atltlress (number and streef, tiry, sfafe, antl LPcade)
7f e0 ' ,B (o�f�
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Land not exceetling 7(one) acre immediately � �,�-;�z'M,�....�.,�� ���.���^
surtoundin resitlendalim rovements. � � -°+�=x»_.?k:5c�%rr+.- �:...:sx,a
k'�-s.m�.,�' s
Otherland (z) .-�.Y...:;�_:�
Total land (line 1 plus lina 2) (3)
oY.em�g �a� '�:.� � -� u`�",�` -�� � �
Residential Improvements arMnuaily . - E'ssa'St�`�'� ��"�"�
Assessed Mohite I Manufac[uretl Homa 9 (5) � �*� � �" `�� �`` '
Gare e � +ao ��y1�ip5iu�...-,,'��s.
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otherimprovemenss (6) i��` �s� yx'�
Total improvements (line a thmugh Ilne 6) (7)
Tofal value (line7 Plis Ilne � (8)
I here6y certify the above is true, cortect, Sigriawre of Assessor Da;e signed (rtronN, day, year)
and complete.
Vaifyi(g ac�on - Sigriawra of PLtlitw ' ' ' Date sgned (rtanN. daY. Y�)
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20 _ pay 20 Lesser of 60 % o( the�assessed value of the homestead or $45,000
Notwi(hslarMirg eny otherpmvision, Ne wm W the deducliortc providetl in IC G1.1-17 to a mobde home Nal is g
rwt assessed es reel property or to a menufectured home Ihat is nof assassed as real propeny maY not erceed
one-haH (i2) W Ne assessetl vdlue ot Na rtabda Mme w manularturetl hame.
SlgnaWre ot I Date si9ned (monf^-h1.�EaY. Y�1�
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