Homestead_McClain4
11
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD If SUPPLEMENTAL DEDUCTION
S • State Form 5473 (R12 / 6-M)
'a Prescribed by the Department of Local Government Finance
INSTRUCTIONS. See reverse side for riling instructions.
APR 5 2011
STATEMENT
—CERTIFICATION
I (We) (T T a certify that I (we) occupied ur) principal
place of residence or am (are) buying the follows described real property for which a Homestead Property TW+.��ici/rsiQ aimed
under contract on the date this application is filed, (date or filing): '
I (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 daunant (legal e
Social Seaxdy of datnanl (6.0 dgis)
Diners fixnse I IdentGxation
Issuug State
Social Seaaity numb&,Ia,'� ouse (last five flg ts) Drivers ficense I Identification I
CONTRACT RECORDED
R buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
Courtly
Township Taxing d'slh city, town, ip) -7Z- ,
l 0�
Parcel number
L al des ' tion pJ Is the property m question:
'
7 to -V.99 Real property ❑ Annually assessed mobile home (IC 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately sunounds that structure is used to Produce Incone, desmbe the use and portion
of the pmperty utilized to produce In=ne.
00 ao 9
PROPERTY OWNED BY
County Township -
County Tw Np
I hereby certify the above statements am true, correct and complete.
Sigture of claimant
Address (number and sheet, city, state, errd LP code)
30) S�4.t� S !/a �s�4�f S�/ 5'7 3
�P
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE I HOMESTEAD NON-RESIDENTIAL
AT 100% OF TTV I VALUE VALUE
Land not exceeding I (one) acre Immediately t ,.,
surrounding residential Improvements. ( ) _ n `
°`f`
Other land
(2)
,.?4`.y,
Total land (line 1 plus line 2)
(3) -
Dwelling
(4)
5 Y•.. y ry .yi+s
Residential improvements or MnuaOy
Assessed Mobile I Manufactured Home
Garage
(5)
r`y' ✓.}.n - -; s �-i3' f. "s.
;x',�RF- �. :i`�' -.�.. ��.. �3t,- -�`x'r :•ate.
Other Improvements
(6)
Try �
Pmr1l;t`'ifi%'RP
Total improvements (line 0 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Astor
Date signed (month, day, year)
STANDARD DEDUCTION
20 pay 20 Lesser of 60% of the assessed value of the homestead or 845,000
NoMihst,ndlg any ofherpmvision the scan of the deducbms provided in IC 61.1 -12 to a mobile tome that Is
$
not assessed as real property or to a manufaWred home Nat is not assessed as real property may not exceed
one -half (12) of the assessed value of the rnobile home or manufactured hone.
Signature of Auditor
Date signed (month, day, year)