Homestead_McCandless (7)Ll
E
CLAIM FOR HOMESTEAD PROPERTY TAX
z STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5073 (R12/6-09)
'O Presaibed by the Departrtcem of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
MAR 2 3 2011
CERTIFICATION
I (We) C certify that I (we) occupied y r) principal
place of residence or am (are) buying the following described real property for which a Homestead Property Ta>L3111@Q(Q W0*?ysA claimed
contract on the date this application is filed, (date of filing): UFi
��ucnd�er
JUI (We) own ❑ Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation -
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
Name of claimant (legal name)
a e
Name of dalmant's spouse (legal name)
Social Security number of claimant's spouse (last five digits) Drivers license I Identification I Other number Iswing Sate
of claimant's spouse (last five digits) '
CONTRACT ••r r
If buying on contract, Fee Simple ownees tame
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
township
raring dis " (city, town, township) )
Parcel number
ILdescription
Is the property in question:
a
SC pZ 6
Real property ❑ AnnuaOy assessed mobile home (IC &7.7 -7)
If any portion of the residential structure or the aced not exceedbg one (1) acre that Immediately surrounds that structure Is used to produce income, desrnbe the use and potion
of the property utilized to pmduco Income.
PROPERTY OWNED BY
County township County Township
I hereby certify the above statements are true, comect and complete.
Sglvoqure of claimant
Ad and s l;I11, and a)�/+
�(/ S
J� LQ •� U G , lc -ice /✓ % �v
l r
r VALUEJ HOMESTEAD NON-RESIDENTIA
ASSESSOR USE ONLY AT 100% OF TTV I VALUE VALUE
1 TRUE TAX VALUE
Land not exceeding 7 (one) acre Immediately
surrounding residential improvements.
5U
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
impro
Garage
(5)
ManufatrAnnually
AsResidential
Assessed Meblle I Manufactured Home
Other Improvements
(6)
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
hereby certify the above is true, correct,
Sgnature of Assessor
Date signed (month, day, year)
and complete.
Vnilying action - Signature of Auditor
Dale signed (month, day, year)
STANDARD • r
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or S45,000
Nahvtlhsanding any otherprovision, the sum of the deductions provided in IC 61.1 -12 to a mobile lame that is
$
tar assessed as real property or to a manufactured home Chet Is not assessed as real property may not exceed
one�haff (1)2) of the assessed value of the mobile home or manufactured home.
Signature of Auditor
Data signed (month, day, year)