HomeMy WebLinkAboutHomestead_KammererCLAIM FOR HOMESTEAD PROPERTY TAX
1 _^ ? STANDARD / SUPPLEMENTAL DEDUCTION
Stale Fortn 5473 (R72 / 6-W)
�' � Pfescnbed Gy 1he DepaM�ent of Loral GwemmeM Frerice
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INSTRUCTIONS: See raverse side !or filing instnictions. � `yjj �
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� M'e) certiry that I(vre) occupied as my (our) prindpal
pWce of resiCence or am (are) buying ihe followin described real pmpery tor which Homestead Property Tax Standard DeduUion is hereby daimed
untler convaG on ihe date Nis applinGOn is filed, - (tlate of filin
9)
�(we) own ❑ Am (are) buying under recorded coniract
Am (are) entltled to oceupy as a tenanbstockholder of a cooperetive housing mrporauon
� Have a benefidal interest in ihe Wst or the rigM ro occupy the pmperry under the tertns of a qualified personal residence wst
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Nartre daimam(legalremej
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Narne of da'irttani's spouse (legal name)
Sodal Sewriry mimber ot dalmant's spouse (last Irve dgrts) Drivets Grense / Iduitlfira0on / OfhM number Issu'vmg br°
of daimanCs spouse (las( frve dgits)
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If byvig on rnnVaU, Fee Simple ownefs �ame � �
Remrdefs ottxb where mntrad is remrded Reard number Page
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Counry Tovmship T' dis (ciry, fown. (owrishi0)
Parcel numher Legal dewiplion Is �he p�operty in questian:
b �� — � ai properry ❑ Mnua%assessed mobile hame (1C St.f-7)
�If arry portion W Ne resiEenital sWdure or ihe WM not esreeC'ug me (1) acre that immetliately surtouM Ihat sWCW2 is used �n produca I�orna, desrfibe Ne use a`d portion
of Ne property uN'aeC to pmdure inmme.
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Counry To.mShiP Caunry Twmship
I hereby certify the above statements are we, correu and complete. Signawre ol dafmam �
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Address (numDeraMSVee(, ary, state, arNLPcotle)
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I.and not exceetling t(one) acre immediauty irt`�-� ��., �� s.�' ��usl :;.';=
sunoundin resitlentialim rovemen6. ��� $.+.°'..4i� ' �j�E'":;�' � ��4.sKn:
Other land (2) �w-�"c�`t•�"=:�`�
,��`�u'.'"':`Li-r. �i�.
Total land (line 1 plus line 3) (3)
Residential Improvemenb or Mnualty �eliing (4) �?'� b�����.��t�r,� ��,�
Auessetl Mobile 1 Manutactured Home 1 '``��+�
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n ���a.
�a.��� � Y �+��
Garage �5) �. - z � Gr., k��y�^,
%- y��wR_S�- �L•
Other improvemems (6) ,�?'�:�.vs���xr_:
Total Improvemenb (llne 1 Nrough ltne � (7)
Total valua (llna7 plls line 7� (8)
I hereby certiy the above is true, correct, �9^�re ofAssessor Da�e slgned (mrnth, day, yea�
and complete.
Vailying a�on - SignaW re o(lv�ditn Date si{{ned (rtronN, tlay, yea�
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20 _ pay 20 Lesser ot 60% of the assessed value of the homestead or 545,000
NoMiNSlaMirg eny aher provisiwi, fha sum N Ne dedurlions pravitlad in IC G7.1-12 to a mo6l7e Inme Nat is g
nof essessea es real propeRy wW e manNeUUreC home Nat is not assessed as real property mey nat erreed
one-hatl (1/1) oI fhe assessed rdlue o1Ne mobde fwme w manufacturetl horrie.
SignaWreolAUEltw Oaiesi9neE(manlh.OaJy/� �
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